A retrospective 7-years study of aluminum phosphide poisoning in

4 downloads 0 Views 63KB Size Report
Sciences, Arak University of Medical Sciences, Arak, Iran. The objective of this study ... treatment, signs and symptoms of intoxication at admis- sion, therapeutic ...
Human & Experimental Toxicology (2009) 28: 209–213 www.het.sagepub.com

A retrospective 7-years study of aluminum phosphide poisoning in Tehran: opportunities for prevention S Shadnia1, G Sasanian2, P Allami1, A Hosseini2, A Ranjbar2,3, N Amini-Shirazi2 and M Abdollahi1,2 1Loghman-Hakim Hospital Poison Center, School of Medicine and Toxicological Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran; 2Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences Tehran, Iran; and 3School of Paramedical Sciences, Arak University of Medical Sciences, Arak, Iran

The objective of this study was to survey aluminum phosphide (AIP) poisoning in a referral poisoning hospital in Tehran servicing an estimation of 10,000,000 populations. Records of all patients admitted and hospitalized during a period of 7 years from January 2000 to January 2007 were collected and analyzed according to gender, age, cause of intoxication, amount of AIP consumed, route of exposure, time between exposure and onset of treatment, signs and symptoms of intoxication at admission, therapeutic intervention, laboratory tests, and outcome. During the studied years, 471 patients were admitted to the hospital with AIP poisoning; 50% of them were men. The overall case fatality ratio was 31%. The mean age was 27.1 years, and most of the patients were between 20 and 40 years old. Self-poisoning was observed in 93% of cases. The average ingested dose was 5.1 g, and most of the patients (73%) consumed 1–3 tablets of AIP. A wide range of symptoms and signs was seen on admission, but the most common one was cardiovascular manifestations (78.12%). The majority (65%) of patients were from Tehran. Poisoning in spring and win-

ter (34% and 24%, respectively) was more common than other seasons. Gastric decontamination with potassium permanganate, and administration of calcium gluconate, magnesium sulfate, sodium bicarbonate, and charcoal were considered for most of the patients. Mean arterial blood pH was 7.23 and bicarbonate concentration was 12.7 mEq/L. One-hundred percent of patients with blood pH 12 h, died, respectively. A wide range of symptoms and signs were seen, and among them cardiovascular disturbances especially hypotension was the most frequent manifestation on admission time (Table 2). The most common clinical manifestation after onset of poisoning was gastrointestinal disturbances. Forty-three percent of cases showed vomiting just after poisoning at home before reaching hospital. As illustrated in Table 1, there was no significant difference between two groups according to immediate vomiting after onset of overdose. In addition, no significant correlation was found between early vomiting after ingestion and the outcome of patients (r2 = 0.022). All the patients, who admitted before 6 h, received gastric decontamination with permanganate potassium (1:10,000), and activated charcoal (1 g/kg) in the emergency room. Administration of calcium gluconate 10% (1 g every 6 h, intravenously), magnesium sulfate (1 g every 6 h, intravenously), and sodium bicarbonate (intravenously and/or orally) were considered for all the patients. Coconut oil (100 mL, orally) administration was only considered for the patients who admitted before 1 h of ingestion. According to the situation of the patients, some of them received vasopressors such as norepinephrine and dopamine. About 59% of patients admitted in ICU and remaining admitted in general ward. The duration of hospitalization in most of the cases (63%) was less than 1 day. In 3% of the cases, the duration of hospitalization was more than 5 days and the rest was between 1 and

Retrospective 7-years study of AIP poisoning in Tehran S Shadnia, et al.

211 Table 1 The age, gender, time interval between onset of overdose and admission to hospital, and clinical and paraclinical information of patients

Age (years)

Age group 12–20 21–40 41–60 >60

Male Female 26% 5% 61% 81% 13% 12% 0% 2% Sex Male Female Immediately vomiting after ingestion Positive Negative Time interval between onset of toxicity and admission (minute) Number of AIP tablets EKG changes on admission time Positive Negative pH on admission time HCO3 on admission time (mEq/L)

Total 22% 66% 9% 3%

Survival (n = 325)

Non-survival (n = 146)

P

24.38 ± 8.81

30.87 ± 14.80

0.11

139 (43%) 186 (57%) 124 201 188.5 ± 125.6 1.49 ± 0.93 186 139 7.32 ± 0.08 14.36 ± 3.30

107 (73%) 39 (27%) 78 68 496.2 ± 577.4 1.92 ± 0.86 136a 10 7.07 ± 0.18a 9.95 ± 2.71a

0.07 0.38 0.26 0.19 0.005 0.0003 0.0002

Data are mean ± SD. difference between survival and non-survival patients is significant.

aThe

5 days. Analysis of ABGs was performed for all patients on admission time. Mean pH and bicarbonate concentration were 7.23 and 12.7 mEq/L, respectively. One-hundred percent of patients with blood pH