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Using Intra-Aortic Balloon Pump for Management of Cardiogenic Shock Following Aluminum Phosphide Poisoning; Report of 3 Cases

Ahmad Bagheri-moghaddam, Hassan Abbaspour, Shahrad Tajoddini, Vahideh Mohammadzadeh, Ali Moinipour, Bita Dadpour
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Abstract

Introduction: Aluminium phosphide (Alp) poisoning mortality rate has been reported as high as 70-100%, and refractory hypotension and cardiogenic shock are the two most common presentations leading to death. Due to lack of specific antidote, all treatments are focused on supportive care and recently, intra-aortic balloon pump (IABP) has been suggested to treat cardiogenic shock resulting from toxic myocarditis. In the current paper, we introduce three Alp poisoned patients for whom IABP was applied to manage their refractory shock. Case presentation: Two men and one woman who were admitted to emergency department (ED) of Imam Reza academic Hospital, Mashhad, Iran due to intentional Alp poisoning are reported. The cases visited the ED shortly after ingestion and nearly all of them showed hypotension, tachycardia and metabolic acidosis during early hospitalization. Due to persistent shock state, despite receiving intravenous fluid therapy and vasopressor agents, IABP insertion was performed in these cases. Finally, one of them survived and the other two died. Conclusion: It still cannot be decided whether IABP insertion is effective in cases of Alp poisoning or not. It might be reasonable to try this intervention along with other conservative treatments in patients who survive more than 12 hours and consistently suffer from refractory hypotension.


Keywords

Poisoning; shock, cardiogenic; intra-aortic balloon pumping; patient outcome assessment

References

Mehrpour O. Comment on “An update on toxicology of aluminum phosphide”. Daru. 2012;20(1):50.

Mehrpour O, Keyler D, Shadnia S. Comment on Aluminum and zinc phosphide poisoning. Clinical toxicology. 2009;47(8):838-9.

Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology. 2012;63(1):61-73.

Shadnia S, Mehrpour O, Soltaninejad K. A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome. 2011.

Shadnia S, Mehrpour O, Abdollahi M. Unintentional poisoning by phosphine released from aluminum phosphide. Human & experimental toxicology. 2008;27(1):87-9.

Mehrpour O, Singh S. Rice tablet poisoning: a major concern in Iranian population. Human & experimental toxicology. 2010;29(8):701-2.

Mehrpour O, Amouzeshi A, Dadpour B, Oghabian Z, Zamani N, Amini S, et al. Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology. 2014;65(1):121-7.

Hashemi-Domeneh B, Zamani N, Hassanian-Moghaddam H, Rahimi M, Shadnia S, Erfantalab P, et al. A review of aluminium phosphide poisoning and a flowchart to treat it. Arhiv za higijenu rada i toksikologiju. 2016;67(3):183-93.

Kumar U, AG VK. Fatal Aluminium Phosphide Poisonings in Nagamangala Taluq-A Retrospective Study. Indian Journal of Forensic Medicine & Toxicology. 2017;11(2).

Agrawal VK, Bansal A, Singh RK, Kumawat BL, Mahajan P. Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote. Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2015;19(2):109-12.

Mehra A, Sharma N. ECMO: A ray of hope for young suicide victims with acute aluminum phosphide poisoning and shock. Indian heart journal. 2016;68(3):256-7.

Neki N, Shergill GS, Singh A, Kaur A, Nizami S, Singh T, et al. Recent Advances in Management of Aluminium Phosphide Poisoning. Int J Curr Res Med Sci. 2017;3(4):73-6.

Mirakbari S. Hot charcoal vomitus in aluminum phosphide poisoning-A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature. Indian journal of anaesthesia. 2015;59(7):433-6.

Taghaddosinejad F, Farzaneh E, Ghazanfari-Nasrabad M, Eizadi-Mood N, Hajihosseini M, Mehrpour O. The effect of N-acetyl cysteine (NAC) on aluminum phosphide poisoning inducing cardiovascular toxicity: a case-control study. SpringerPlus. 2016;5(1):1948-.

Halvaei Z, Tehrani H, Soltaninejad K, Abdollahi M, Shadnia S. Vitamin E as a novel therapy in the treatment of acute aluminum phosphide poisoning. Turkish journal of medical sciences. 2017;47(3):795-800.

Siddaiah LM, Adhyapak SM, Jaydev SM, Shetty GG, Varghese K, Patil CB, et al. Intra-aortic balloon pump in toxic myocarditis due to aluminum phosphide poisoning. Journal of medical toxicology. 2009;5(2):80-3.

D’sa SR, Peter JV, Chacko B, Pichamuthu K, Sathyendra S. Intra-aortic balloon pump (IABP) rescue therapy for refractory cardiogenic shock due to scorpion sting envenomation. Clinical Toxicology. 2016;54(2):155-7.

Mehrpour O, Gurjar M. Cardiogenic Shock: The Main Cause of Mortality in Acute Aluminum Phosphide Poisoning. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2017;21(4):246-7.

Bansal P, Giri S, Bansal R, Tomar LR. Survival in a case of aluminum phosphide poisoning with severe myocardial toxicity. Indian Journal of Health Sciences and Biomedical Research (KLEU). 2017;10(3):343.

Akkaoui M, Achour S, Abidi K, Himdi B, Madani A, Zeggwagh AA, et al. Reversible myocardial injury associated with aluminum phosphide poisoning. Clinical toxicology. 2007;45(6):728-31.

Lane AS, Woodward AC, Goldman MR. Massive propranolol overdose poorly responsive to pharmacologic therapy: use of the intra-aortic balloon pump. Annals of emergency medicine. 1987;16(12):1381-3.

Chacko J, Shivaprasad C. Fatal aluminium phosphide poisoning due to myocardial depression refractory to high dose inotropic support and intra-aortic balloon counterpulsation. Indian Journal of Critical Care Medicine. 2008;12(1):37.




DOI: https://doi.org/10.22037/emergency.v6i1.19129

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