Prognostic Factors of In-Hospital Mortality in Adult Patients With Aluminum Phosphide (ALP) Poisoning in Southern Iran (2014-2018) Prognostic factors of mortality in ALP poisoning
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 11 No. 4 (2021),
17 November 2021
,
Page 34976
https://doi.org/10.32598/ijmtfm.v11i4.34976
Abstract
Background: The suicide with aluminum phosphide, known as rice tablet, has increased significantly. This study aimed to investigate the epidemiology of Aluminum Phosphide (ALP) poisoning and determine the in-hospital mortality prognostic factors in adult people referring to ALP poisoning to one of the main poisoning centers in southern Iran.
Methods: This retrospective cross-sectional study (March 21, 2014, to March 21, 2018) was conducted on all adult patients (>16 years) with ALP poisoning who were referred to Ali-Asghar Hospital (affiliated with Shiraz University of Medical Sciences). All data were extracted from the patients’ medical files. The patients were categorized into two groups of survived and non-survived. Univariate and multivariate logistic regression analyses were conducted to determine prognostic factors for in-hospital mortality, and Odds Ratios (ORs) were reported.
Results: Totally, 97 patients were enrolled in this study. The patients’ Mean±SD age was 29.3±12.2 years. Both study groups (survived and non-survived) were matched in most demographic and poisoning characteristics. Nausea (62.9%) and vomiting (49.5%) were the most symptoms at the time of admission. Castor oil (66%), N-acetyl cysteine (56.7%), and magnesium sulfate (52.6%) were the most frequent treatment in these patients. The multivariate analysis showed that age (OR=1.12, 95%CI: 1.03-1.22), body temperature (OR=0.02, 95%CI: 0.01-0.48), resistant acidosis (OR=77.10, 95%CI: 5.05-1176.86), and taking sodium bicarbonate (OR=12.35, 95%CI: 1.25-122.10) were the prognostic factors of in-hospital mortality.
Conclusion: The in-hospital mortality rate in patients with ALP poisoning was 29.9%. Age, illiteracy, body temperature, resistant acidosis, and taking sodium bicarbonate were the prognostic factors of in-hospital mortality in these patients.
- Aluminum phosphide
- Poisoning
- Prevalence
- Prognostic factor
How to Cite
References
Shokrzadeh M, Zarei H, Jalilian J, Badeli A, Ebrahimi Falahtalab F, Shayeste Y. [A comparison of mortality rate caused by Aluminum Phosphide with other poisonings in Golestan Province, Iran, 2010 – 2016 (Persian)]. Med J Mashhad Univ Med Sci. 2017; 60(5):689-90. https://mjms.mums.ac.ir/article_10453.html
Shadnia S, Mehrpour O, Soltaninejad K. A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome. Indian J Med Sci. 2010; 64(12):532-9. [PMID]
Navabi SM, Navabi J, Aghaei A, Shaahmadi Z, Heydari R. Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: Characteristics and predictive factors. Epidemiol Health. 2018; 40:e2018022. [DOI:10.4178/epih.e2018022] [PMID] [PMCID]
Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J. 2006; 23(1):e3. [DOI:10.1136/emj.2004.015941] [PMID] [PMCID]
Shokrzadeh M, Alizadeh A, Veisi F, Nasri-Nasrabadi N. [The mortality rate of aluminum phosphide poisoning; a comparison with other poisonings recorded in Mazandaran Department of Forensic Medicine, Iran, 2009-2011 (Persian)]. J Isfahan Med School. 2015; 33(322):114-24. http://jims.mui.ac.ir/index.php/jims/article/view/4100
Shadnia S, Soltaninejad K, Hassanian-Moghadam H, Sadeghi A, Rahimzadeh H, Zamani N, et al. Methemoglobinemia in aluminum phosphide poisoning. Hum Exp Toxicol. 2011; 30(3):250-3. [DOI:10.1177/0960327110384287] [PMID]
Mehrpour O, Alfred S, Shadnia S, Keyler DE, Soltaninejad K, Chalaki N, et al. Hyperglycemia in acute aluminum phosphide poisoning as a potential prognostic factor. Hum Exp Toxicol. 2008; 27(7):591-5. [DOI:10.1177/0960327108096382] [PMID]
Brautbar N, Howard J. Phosphine toxicity: Report of two cases and review of the literature. Toxicol Ind Health. 2002; 18(2):71-5. [DOI:10.1191/0748233702th133oa] [PMID]
Kaushik RM, Kaushik R, Mahajan SK. Subendocardial infarction in a young survivor of aluminium phosphide poisoning. Hum Exp Toxicol. 2007; 26(5):457-60. [DOI:10.1177/0960327107074618] [PMID]
Taheri S K, Afzali S, Khaled Naghshbandi M, Norouzi F, Mohammadi N. [Report of two cases of accidental poisoning due to “rice tablet” misuse (Persian)]. Iran J Forensic Med. 2011; 17(3):199-203. http://sjfm.ir/article-1-470-fa.html
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. Arh Hig Rada Toksikol. 2014; 65(1):121-6. [DOI:10.2478/10004-1254-65-2014-2393] [PMID]
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. Arh Hig Rada Toksikol. 2016; 67(3):183-93. [DOI:10.1515/aiht-2016-67-2784] [PMID]
Marashi SM, Nasri-Nasrabadi Z. Can sodium bicarbonate really help in treating metabolic acidosis caused by aluminium phosphide poisoning? Arh Hig Rada Toksikol. 2015; 66(1):83-4. [DOI:10.1515/aiht-2015-66-2637] [PMID]
Etemadi-Aleagha A, Akhgari M, Iravani FS. Aluminum phosphide poisoning-related deaths in Tehran, Iran, 2006 to 2013. Medicine (Baltimore). 2015; 94(38):e1637. [DOI:10.1097/MD.0000000000001637] [PMID] [PMCID]
Sharma T, Sharma A, Kapoor D. Profile of aluminum phosphide poisoning in a tertiary care institute in the sub-Himalayan region. J Family Med Prim Care. 2018; 7(3):581-3. [DOI:10.4103/jfmpc.jfmpc_231_17] [PMID] [PMCID]
Alnasser S, Hussain SM, Kirdi TS, Ahmed A. Aluminum phosphide poisoning in Saudi Arabia over a nine-year period. Ann Saudi Med. 2018; 38(4):277-83. [DOI:10.5144/0256-4947.2018.277] [PMID] [PMCID]
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 J Crit Care Med. 2015; 19(2):109-12. [DOI:10.4103/0972-5229.151019] [PMID] [PMCID]
Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol. 2012; 63(1):61-73. [DOI:10.2478/10004-1254-63-2012-2182] [PMID]
Sinha N. Aluminium phosphide poisoning. Indian J Med Specialities. 2018; 9(3):167-70. [DOI:10.1016/j.injms.2018.06.006]
Murali R, Bhalla A, Singh D, Singh S. Acute pesticide poisoning: 15 years’ experience of a large North-West Indian hospital. Clin Toxicol (Phila). 2009; 47(1):35-8. [PMID]
Farzaneh E, Ghobadi H, Akbarifard M, Nakhaee S, Amirabadizadeh A, Akhavanakbari G, et al. Prognostic factors in acute aluminium phosphide poisoning: A risk-prediction nomogram approach. Basic Clin Pharmacol Toxicol. 2018; 123(3):347-55. [DOI:10.1111/bcpt.13005] [PMID]
Kordrostami R, Akhgari M, Ameri M, Ghadipasha M, Aghakhani K. Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015. Daru. 2017; 25(1):15. [DOI:10.1186/s40199-017-0181-1] [PMID] [PMCID]
Walker HK, Hall WD, Hurst JW, editors. Clinical methods: The history, physical, and laboratory examinations. 3rd ed. Boston: Butterworths; 1990. [PMID]
Sharma S, Hashmi MF, Bhattacharya PT. Hypotension. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. [PMID]
Alizadeh A, Rakhshanizadeh F. Loss of consciousness in a little traveler. Caspian J Intern Med. 2021; 12(1):103-6. [PMID]
Makris K, Spanou L. Acute kidney injury: Definition, pathophysiology and clinical phenotypes. Clin Biochem Rev. 2016; 37(2):85-98. [PMID]
Montazer H, Laali A, Khosravi N, Amini Ahidashti H, Rahiminezhad M, Mohamadzadeh A. [Epidemiological, clinical and laboratory features in patients poisoned with aluminum phosphide (Persian)]. J Mazandaran Univ Med Sci. 2016; 26(137):188-95. http://jmums.mazums.ac.ir/article-1-7716-en.html
Christophers AJ, Singh S, Goddard DG, Facem AN. Dangerous bodies: A case of fatal aluminium phosphide poisoning. Med J Aust. 2002; 176(8):403 [DOI:10.5694/j.1326-5377.2002.tb04471.x]
Rahbar Taramsary M, Orangpoor R, Zarkami T, Palizkar M, Mousavian S. [Survey patients poisoned with aluminum phosphide (Rice Tablet) (Persian)]. J Guilan Univ Me Sci. 2006; 14(56):42-7. http://journal.gums.ac.ir/article-1-494-en.html
Nosrati A, Karami M, Esmaeilnia M. Aluminum phosphide poisoning: A case series in North Iran. Asia Pac J Med Toxicol. 2013; 2(3):111-3. [DOI:10.22038/APJMT.2013.1674]
Hosseinian A, Pakravan N, Rafiei A, Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran. Indian J Med Sci. 2011; 65(4):143-50. [PMID]
Shadnia S, Sasanian G, Allami P, Hosseini A, Ranjbar A, Amini-Shirazi N, et al. A retrospective 7-years study of aluminum phosphide poisoning in Tehran: Opportunities for prevention. Hum Exp Toxicol. 2009; 28(4):209-13. [DOI:10.1177/0960327108097194] [PMID]
Aziz U, Husain A. Frequency of cardiac arrhythmias in patients with aluminum phosphide poisoning. Asia Pac J Med Toxicol. 2015; 4(4):147-50. [DOI:10.22038/APJMT.2015.6257]
Khodabandeh F, Kahani A, Soleimani G. [The study of fatal complications of “rice tablet “poisoning (Persian)]. Iran J Forensic Med. 2014; 20(2):27-36. http://sjfm.ir/article-1-584-en.html
Siddaiah L, Adhyapak S, Jaydev S, Shetty G, Varghese K, Patil C, et al. Intra-aortic balloon pump in toxic myocarditis due to aluminum phosphide poisoning. J Med Toxicol. 2009; 5(2):80-3. [DOI:10.1007/BF03161093] [PMID] [PMCID]
Saha JK, Azad KAK, Hossain MZ, Amin MR, Ahmed M, Ahsan HMN, et al. Aluminium phosphide poisoning cases in a tertiary care hospital. J Dhaka Med Coll. 2014; 23(1):3-6. [DOI:10.3329/jdmc.v23i1.22685]
Ranga G, Dwivedi S, Agarwal M, Kumar D. Aluminium phosphide poisoning in a young adult: A suicidal cardiotoxin simulating myocardial ischaemia. J Indian Acad Clin Med. 2004; 5(4):369. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=+2004&btnG=
Fayaz A. [Evaluation of related factors in pulmonary edema and aspiration pneumonia among rice tablet poisonings (Persian]. EBNESINA. 2014; 16(1-2):72-8. http://ebnesina.ajaums.ac.ir/article-1-288-en.html
Taghadosinejad F, Behnoush B, Okazi A, Marashi S M, Mohseni K, Sadeghian M. [A study of poisoning induced shock in patients referred to Baharloo Hospital from June 2011 to June 2012 (Persian)]. Razi J Med Sci. 2014; 21(119):49-59. http://rjms.iums.ac.ir/article-1-3102-en.html
Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci. 2009; 63(6):227-34. [PMID]
Ahmadi H, Soleimani A. Suicides resulting in death by poisoning among patients referred to Imam Khomeini Hospital in Kermanshah (2007-10). J Kermanshah Univ Med Sci. 2013; 17(3):e77111. https://sites.kowsarpub.com/jkums/articles/77111.html
Yaghoobi Y, Shafi Poor Z. [Survey socio-demographic characteristics of adolescents attempted suicide with rice tablet in Razi Hospital in Rasht (Persian)]. J Holist Nurs Midwifery. 2007; 17(2):45-50. http://hnmj.gums.ac.ir/article-1-259-en.html
Shadnia S, Mehrpour O, Abdollahi M. Unintentional poisoning by phosphine released from aluminum phosphide. Hum Exp Toxicol. 2008; 27(1):87-9. [DOI:10.1177/0960327107086241] [PMID]
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. [DOI:10.1186/s40064-016-3630-2] [PMID] [PMCID]
Najafi F, Mousavi-Roknabadi RS, Pirdehghan A, Rahimian M, Nourimajalan N. The effect of n-acetylcysteine on hsCRP in patients on continues ambulatory peritoneal dialysis; A quasi-experimental study. Nephrourol Mon. 2021; 13(3):e113990. [DOI:10.5812/numonthly.113990]
Soltaninejad K, Beyranvand MR, Momenzadeh SA, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. J Forensic Leg Med. 2012; 19(5):291-3. [DOI:10.1016/j.jflm.2012.02.005] [PMID]
- Abstract Viewed: 448 times
- pdf Downloaded: 320 times