Cardiovascular manifestations of acute aluminium phosphide poisoning and their impact on survival

Background: Aluminium phosphide (AlP) is a common suicidal poison with a high mortality rate due to its cardiovascular impact and lack of antidote. The aim of the study wasto describe the electrocardiographic changes and other cardio-vascular manifestations in acute AlP poisoning and evaluate its impact on survival outcomes.Methods: A prospective cross-sectional study was conducted in a tertiary care hospital including patients who presented with acute AlP ingestion in any form. Patients’ vitals and ECG at the time of admission were taken and outcomes of survival were identified. A descriptive study of echocardiography was also done. The clinical parameters were correlated with the survival outcomes.Results: Fifty patients were included with 30 males and 20 females. The consumption of AlP in tablet form caused more hemodynamic compromise (hypotension and high anion gap metabolic acidosis) as compared to the powder form. ECG changes were seen in 42% of the cases, the most common finding was prolonged QTc interval (26%). The mortality was 30%.Hypotension, bradycardia, and QRS widening were found to be significant predictors of mortality (p<0.05). Echocardiography was performed for 10 patients, of which, one had right ventricular dysfunction and two had left ventricular dysfunction. Conclusions: AlP tablets are more lethal and hemodynamically compromising than AlP powder. Hypotension, bradycardia, and QRS widening are significant predictors of mortality. Direct cardiotoxicity leads to ECG changes, of which, QTc prolongation is the most common.

Aluminium Phosphide Poisoning.

Aluminium phosphide poisoning is a major cause of morbidity and mortality in northwest and central India. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. The mechanism of toxicity includes cellular hypoxia due to the effect on mitochondria, inhibition of cytochrome C oxidase and formation of highly reactive hydroxyl radicals. In India, most of the patients who come with Celphos poisoning succumb to its toxicity because of the considerable time gap between the ingestion of the poison and the initiation of proper treatment. This has led to widely prevalent scepticism among physicians while managing cases of Celphos poisoning. Due to no known specific antidote, management remains primarily supportive care. In most of the studies, poor prognostic factors were presence of acidosis and shock. The overall outcome improved in the last decade due to better and advanced intensive care management.

Clinical profile of celphos poisoning in central India.

Celphos poisoning (trade name of aluminium phosphide) is a large, though under-reported, problem in the Indian subcontinent. Methods: The study was conducted at the Intensive Care Unit (ICU) of a tertiary care teaching hospital of central India. Data were collected by a retrospective chart review of all patients admitted from February 2010 to February 2014 with a diagnosis of celphos poisoning. Results: Fifty patients (32 females, 18 males) were registered from the 967 patients of poisoning admitted to the ICU during the same period, of whom 44 (88%) had died (non-survivors) and the remaining 6 (12%) had survived. Forty five cases were of suicidal poisoning, and 5 were of accidental poisoning. Majority [42/50 (84%)] were from rural background. The ingested dose was 7.23 ± 1.28 gram among non-survivors and 3.3 ± 1.9 gram among survivors. Conclusion: Strict implementation of nationwide pesticide regulation, including restricting the availability of poison, being aware of its toxicity and providing improved medical management in consultation with regional or national poison control centers could further reduce the mortality due to ALP toxicity as there is no antidote available presently.