15
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      A case of aluminum phosphide poisoning managed successfully in Nepal: a case report Translated title: Un caso de intoxicación por fosfuro de aluminio manejado con éxito en Nepal: informe de un caso

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Abstract Aluminum phosphide (ALP) is a highly toxic compound most commonly available as Celphos in Nepal. Suicidal ingestion is common in developing countries like Nepal as it is easily available and has a high mortality rate. Farmers to protect crops from rodents and pests use it. Here we present a case of a 24-year-old female with suicidal ingestion of one and a half-tablet of ALP presented with abdominal pain and vomiting. The patient developed metabolic acidosis, hyperkalemia, acute respiratory distress, and hypotension during the Intensive Care Unit stay. Supportive treatment with gastric lavage (coconut oil), intravenous magnesium sulfate, sodium-bicarbonate infusion, adequate vasopressor and close monitoring of hemodynamic parameters helped in the survival of the patient.

          Translated abstract

          Resumen El fosfuro de aluminio (ALP) es un compuesto altamente tóxico más comúnmente disponible como Celphos en Nepal. La ingestión suicida es común en países en desarrollo como Nepal, ya que está fácilmente disponible, teniendo una alta tasa de mortalidad. Los agricultores lo utilizan para proteger los cultivos de roedores y plagas. Aquí presentamos el caso de una mujer de 24 años con ingesta suicida de una tableta y media de ALP que presentó dolor abdominal y vómitos. La paciente desarrolló acidosis metabólica, hiperpotasemia, dificultad respiratoria aguda e hipotensión durante su estancia en la Unidad de Cuidados Intensivos. El tratamiento de soporte con lavado gástrico (aceite de coco), sulfato de magnesio intravenoso, infusión de bicarbonato de sodio, vasopresor adecuado y monitoreo estrecho de los parámetros hemodinámicos ayudaron a la supervivencia del paciente.

          Related collections

          Most cited references13

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          An update on toxicology of aluminum phosphide

          Aluminum phosphide (AlP) is a cheap solid fumigant and a highly toxic pesticide which is commonly used for grain preservation. In Iran it is known as the “rice tablet”. AlP has currently aroused interest with increasing number of cases in the past four decades due to increased use in agricultural and non-agricultural purposesand also its easy availability in the markets has increased its misuse to commit suicide. Upon contact with moisture in the environment, AlP undergoes a chemical reaction yielding phosphine gas, which is the active pesticidal component. Phosphine inhibits cellular oxygen utilization and can induce lipid peroxidation. It was reported that AlP has a mortality rate more than 50% of intoxication cases. Poisoning with AlP has usually occurred in attempts to suicide. It is a more common case in adults rather than teen agers. In some eastern countries it is a very common agent with rapid action for suicide. Up to date, there is no effective antidote or treatment for its intoxication. Also, some experimental results suggest that magnesium sulfate, N-acetyl cysteine (NAC), glutathione, vitamin C and E, beta-carotenes, coconut oil and melatonin may play an important role in reducing the oxidative outcomes of phosphine. This article reviews the experimental and clinical features of AlP intoxication and tries to suggest a way to encounter its poisoning.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Clinical Profile and Treatment Outcome of Aluminum Phosphide Poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: A Retrospective Study

            Background Aluminum phosphide (AlP) is an effective fumigant and rodenticide which is a commonly used agent for self-poisoning in parts of Ethiopia. AlP poisoning results in serious manifestations involving many vital organs and it has high mortality. Despite its high incidence and mortality, studies on AlP poisoning in Ethiopia are lacking. Our objective was to study the clinical profile and treatment outcome of AlP poisoning in Felege Hiwot Referral Hospital (FHRH), a major referral hospital in Ethiopia. Methods It is a retrospective study conducted over all consecutive AlP poisoning cases who presented to the emergency department (ED) of the hospital from March 2018 to August 2020. A questionnaire was used to collect data from patient medical records. All data were analyzed using SPSS 25. Results A total of 125 patients were studied. Females were 57.6% and males were 42.4%. Age of patients ranged from 12 to 60 with mean age 28.5 years. The average number of AlP tablets taken was 1.2 (3.6 gm) and the average time of arrival to hospital after AlP ingestion was 4.8 hours. Nausea and vomiting were the commonest presenting features seen in 74.4% of the cases followed by hypotension which was seen in half of the cases. A wide range of laboratory findings and complications were also observed. Cases of AlP poisoning with hypotension were managed in the ICU with dopamine infusion, magnesium sulphate, hydrocortisone, and calcium gluconate in addition to gastric lavage and fluid administration. Those cases without hypotension were managed with gastric lavage and maintenance fluid only. Overall mortality from AlP poisoning was 31.2%. Conclusion With a treatment protocol used in FHRH, mortality from AlP poisoning was 31.2%. Using this protocol in resource limited settings might give opportunities to reduce mortality from AlP poisoning.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Successfully managed aluminum phosphide poisoning: A case report

              Introduction and Importance: Aluminum phosphide (ALP) is a commonly available pesticide in agricultural countries like Nepal. Upon ingestion, this releases highly toxic phosphine gas in the gastrointestinal tract when it comes in contact with humidity. This leads to refractory shock, metabolic acidosis, cardiac arrhythmia, renal failure, and hepato-biliary impairment. Case presentation We present a successfully managed case of a 17-year-old girl who ingested 6 g (2 tablets) of ALP tablets with suicidal intent. Although the mortality has been reported as 70–100% with mere ingestion of 150–500 mg of ALP, this case survived even after developing severe metabolic acidosis, acute renal failure, refractory shock, and ventricular tachycardia. Clinical discussion ALP poisoning is most often lethal. However, there is an emerging evidence of successful use of various drugs such as magnesium sulfate, trimetazidine, and other interventions such as intra-aortic balloon pump and extra corporeal membrane oxygenation in case of ALP poisoning. Conclusion Owing to the unavailability of an effective antidote of ALP to date, we emphasize early initiation of supportive management, intensive monitoring, and potential role of membrane stabilizers like magnesium sulfate, and cardio-protective agents like trimetazidine, N -Acetyl cysteine, thiamine, vitamin C, and hydrocortisone in decreasing the likelihood of fatal outcome. • Aluminum phosphide poisoning poses a major risk of mortality as it has no specific antidote. • Early supportive management, critical monitoring, and timely intervention of shock and arrhythmia can save a life. • Magnesium sulfate, trimetazidine and N -Acetyl cysteine may add additional advantages in combating the fatal outcome.
                Bookmark

                Author and article information

                Journal
                ijm
                Iberoamerican Journal of Medicine
                Iberoam J Med
                Hospital San Pedro (Logroño, La Rioja, Spain )
                2695-5075
                2695-5075
                2022
                : 4
                : 2
                : 123-127
                Affiliations
                [1] Louisville Kentucky orgnameUniversity of Louisville orgdiv1Department of Molecular Cardiology United States
                [2] Banepa Kavrepalanchok orgnameScheer Memorial Adventist Hospital orgdiv1Department of Internal Medicine Nepal
                Article
                S2695-50752022000200008 S2695-5075(22)00400200008
                10.53986/ibjm.2022.0018
                fcf319c9-9b01-4565-93ee-43aac027c7eb

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 28 January 2022
                : 03 April 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 5
                Product

                SciELO Spain

                Categories
                Case Report

                Magnesium sulfate,Fosfuro de aluminio,Ingesta suicida,Acidosis metabólica,Distrés respiratorio agudo,Sulfato de magnesio,Aluminum phosphide,Suicidal ingestion,Metabolic acidosis,Acute respiratory distress

                Comments

                Comment on this article