Vitamin E as a novel therapy in the treatment of acute aluminum phosphide poisoning.

BACKGROUND/AIM: Aluminum phosphide (AlP) is commonly used as a fumigant in developing countries. Induction of oxidative stress is one of the most important mechanisms of its toxicity. In this regard, and considering that there is no specific antidote for its treatment, the aim of this study was to evaluate the effect of vitamin E in the treatment of acute AlP poisoning. MATERIALS AND METHODS: This was a clinical trial on acute AlP poisoned patients. All patients received supportive treatment. In addition, the treatment group received vitamin E (400 mg/BD/IM). Level of malondialdehyde (MDA) and total antioxidant capacity of plasma were measured. RESULTS: There was no significant difference between the treatment and control groups with regard to demographic, clinical, or paraclinical data or Simplified Acute Physiology Score II (SAPSII) on admission. Systolic blood pressure significantly increased during the first 24 h in the treatment group (P < 0.05). The plasma MDA level significantly decreased in the treatment group (P < 0.05). Vitamin E administration decreased the necessity (30% vs. 62%, P < 0.05) and duration of intubation and mechanical ventilation (P < 0.05). It significantly reduced the mortality rate in the treatment group compared to the control group (15% vs. 50%, respectively, P < 0.05). CONCLUSION: Vitamin E along with supportive treatment could have a therapeutic effect in acute AlP poisoning.

Protective effects of N-acetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning.

OBJECTIVE: Aluminum phosphide is used as a fumigant. It produces phosphine gas (PH3). PH3 is a mitochondrial poison which inhibits cytochrome c oxidase, it leads to generation of reactive oxygen species; so one of the most important suggested mechanisms for its toxicity is induction of oxidative stress. In this regard, it could be proposed that a drug like N-acetylcysteine (NAC) as an antioxidant would improve the tolerance of aluminum phosphide-intoxicated cases. The objective of this study was to evaluate the protective effects of NAC on acute aluminum phosphide poisoning. METHODS: This was a prospective, randomized, controlled open-label trial. All patients received the same supportive treatments. NAC treatment group also received NAC. The blood thiobarbituric acid reactive substances as a marker of lipid peroxidation and total antioxidant capacity of plasma were analyzed. RESULTS: Mean ingested dose of aluminum phosphide in NAC treatment and control groups was 4.8 ± 0.9 g vs. 5.4 ± 3.3 g, respectively (p = 0.41). Significant increase in plasma malonyldialdehyde level in control group was observed (139 ± 28.2 vs. 149.6 ± 35.2 µmol/L, p = 0.02). NAC infusion in NAC treatment group significantly decreased malondialdehyde level (195.7 ± 67.4 vs. 174.6 ± 48.9 µmol/L, p = 0.03), duration of hospitalization (2.7 ± 1.8 days vs. 8.5 ± 8.2 days, p = 0.02), rate of intubation and ventilation (45.4% vs. 73.3%, p = 0.04). Mortality rate in NAC treatment and control groups were 36% and 60%, respectively with odds ratio 2.6 (0.7-10.1, 95% CI). CONCLUSION: NAC may have a therapeutic effect in acute aluminum phosphide poisoning.

Acute and subchronic toxicity assessment of the hydroalcoholic extract of Stachys lavandulifolia in mice.

Stachys lavandulifolia is used as the herbal tea and its wide and potent medical effects have been reported for the extract in animal studies. This study aimed to find the safety profile of the extract to find the appropriate doses for further human studies. The aerial parts of the plant were air-dried and the hydroalcoholic extract was obtained and concentrated by percolation method with 140 mg/ml concentration. To assess the toxicity profile of this extract, 60 female mice (30 cases, 30 controls, 24.8 ± 2.1 g, 4-6 weeks) were administered the extract by oral gavages in acute (24 hrs), subacute (14 days) and subchronic (45 days) models. All clinical, hematological, biochemical and histopathological changes were assessed in appropriate midpoints and endpoints and compared with control group. Doses up to 140 mg/kg were recognized as maximum tolerated dose in subchronic model. Abnormal changes in kidney and liver weight in treatment groups as well as the significant elevation of biochemical parameters in 45 days study has suggested the possible hepatic and renal toxicity potentials of this extract with doses upper than 140 mg/kg. Doses up 70 mg/kg could be considered as no observable adverse effect level (NOAEL) and could be used in further clinical trials on the possible therapeutic effects of this plant.