DEMOGRAPHIC AND CLINICAL PROFILES AND MORTALITY OF ALUMINIUM PHOSPHIDE POISONING CASES IN KHYBER PAKHTUNKHWA PROVINCE, PAKISTAN

Sakhi Jan, Hamid Shahzad, Hassan Naveed, Atta Ullah, Muhammad Bilal, Mahnoor Asad

Abstract


Background: The prevalence of aluminium phosphide (AlP) poisoning is on the rise in Asian countries. The objectives of our study were to determine the distribution of AIP poisoning by sex, age groups & district and its presentation by blood pressure category and oxygen saturation category and its mortality in Khyber Pakhtunkhwa Province, Pakistan.

Materials & Methods: This cross-sectional study was conducted at Emergency Department of Lady Reading Hospital, Peshawar, Pakistan from June 1, 2020 to September 30, 2020. Fifty eight cases of AIP registered during 2019 were included. The diagnosis was made by history and clinical suspicion. All these cases were managed by standard management protocols. Sex, age groups, district, blood pressure category, oxygen saturation category and presence of mortality were variables; all being categorical were analyzed by count and percentage with 80% confidence interval.

Results: Out of 58 AlP poisoning cases, women 34 (58.62%) were more than men 24 (41.38%), with most cases 30 (51.73%) in 10-19 years age group. Most cases 17 (29.31%) were from district Swabi, followed by district Peshawar 16 (27.58%). Most cases presented in non-recordable blood pressure category 19 (32.76%). Most cases 22 (37.93%) presented in oxygen saturation category of ≥ 90%. Out of 58 cases, mortality was 72.41% (42/58), involving more women 24/58 (41.38%) than men 18/58 (31.03%), with most cases 23 (39.66%) in 10-19 years age group. Mortality was highest in non-recordable blood pressure category 19 (32.76%). Mortality was highest 19 (32.76%) in oxygen saturation category of below 90%.

Conclusion: Aluminium phosphide (AlP) poisoning is an uncommon, but a dreadful public health problem in population of Khyber Pakhtunkhwa Province, Pakistan. It involves women more than men, with most cases in adolescent age group, and in non-recordable blood pressure category. AlP poisoning mortality is very high 72.41% in our population, involving more women than men, with most cases in adolescent age group. Mortality is highest in non-recordable blood pressure category and in oxygen saturation category of below 90%.


Keywords


luminium Phosphide; Poisoning; Mortality; Blood Pressure; Hypotension; Ingestion; Sex; Age Groups; Pakistan; Asia.

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References


Alnasser S, Hussain SM, Kirdi TS, Ahmad A. Aluminum phosphide poisoning in Saudi Arabia over a nine-year period. Ann Saudi Med 2018;38(4):277-83. https://doi.org/10.5144/0256-4947.2018.277

Wahab A, Zaheer MS, Wahab S, Khan RA. Acute aluminium phosphide poisoning: an update. Hong Kong J Emerg Med 2008;15(3):152-5. https://doi.org/10.1177/102490790801500306

Ghazi MA. Wheat pill (aluminum phosphide) poisoning; commonly ignored dilemma. A comprehensive clinical review. Professional Med J 2013;20(6):855-63. https://doi.org/10.29309/TPMJ/2013.20.06.1829

Moghadamnia AA. An update on toxicology of aluminum phosphide. Daru 2012;20(1):25. https://doi.org/10.1186/2008-2231-20-25

Nath NS, Bhattacharya I, Tuck AG, Schlipalius DI, Ebert PR. Mechanisms of phosphine toxicity. J Toxicol 2011;2011:494168. https://doi.org/10.1155/2011/494168

Iftikhar R, Tariq KM, Saeed F, Khan MB, Babar NF. Wheat pill: clinical characteristics and outcome. Pakistan Armed Forces Med J 2011;61(3).

Chugh SN, Pal R, Singh V, Seth H. Serial blood phosphine levels in acute aluminium phosphide poisoning. J Assoc Physicians India 1996 Mar;44(3):184-5.

Shadnia S, Rahimi M, Pajoumand A, Rasouli MH, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Hum Exp Toxicol 2005 Apr; 24(4):215-8. https://doi.org/10.1191/0960327105ht513oa

Sanaei-Zadeh H, Farajidana H. Is there a role for digoxin in the management of acute aluminum phosphide poisoning? Med Hypotheses 2011 May;76(5): 765-6. https://doi.org/10.1016/j.mehy.2011.02.023

Siwach SB, Singh P, Ahlawat S. Magnesium in aluminium phosphide poisoning--where have we erred? J Assoc Physicians India 1994;42(3):193- 4.

Chugh SN, Kolley T, Kakkar R, Chugh K, Sharma A. A critical evaluation of antiperoxidant effect of intravenous magnesium in acute aluminium phosphide poisoning. Magnes Res 1997 Sep;10(3):225-30.

Nayyar S, Nair M. Brugada pattern in toxic myocarditis due to severe aluminum phosphide poisoning. Pacing Clin Electrophysiol 2009;32(11):el6-7. https://doi.org/10.1111/j.1540-8159.2009.02522.x

Alter P, Grimm W, Maisch B. Lethal heart failure caused by aluminium phosphide poisoning. Intensive Care Med 2001;27(1):327. https://doi.org/10.1007/s001340000744

Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic-review of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2012;63(1):61-73. https://doi.org/10.2478/10004-1254-63-2012-2182

Tehrani H, Halvaie Z, Shadnia S, Soltaninejad K, Abdollahi M. Protective effects of Nacetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning. Clin Toxicol (Phila) 2013 Jan;51(1):23-8. https://doi.org/10.3109/15563650.2012.743029

Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci 2009 Jun;63(6):227-34. https://doi.org/10.4103/0019-5359.53386

Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J 2006 Jan;23(1):e3. https://doi.org/10.1136/emj.2004.015941

Siwach SB, Gupta A. The profile of acute poisonings in Harayana-Rohtak Study. J Assoc Physicians India 1995;43(11):756-9.

Singh D, Dewan I, Pandey AN, Tyagi S. Spectrum of unnatural fatalities in the Chandigarh zone of north-west India--a 25 year autopsy study from a tertiary care hospital. J Clin Forensic Med 2003 Sep;10(3):145-52. https://doi.org/10.1016/S1353-1131(03)00073-7

Gupta S, Ahlawat SK. Aluminum phosphide poisoning--a review. J Toxicol Clin Toxicol 1995;33(1):19-24. https://doi.org/10.3109/15563659509020211

Etemadi-Aleagha A, Akhgari M, Iravani FS. Aluminium phosphide poisoning-related deaths in Tehran, Iran, 2006 to 2013. Medicine (Baltimore) 2015;94(38):e1637. https://doi.org/10.1097/MD.0000000000001637

Shadnia S, Sasanian G, Allami P, Hosseini A, Ranjbar A, Amini-Shirazi N. A retrospective 7-years study of aluminum phosphide poisoning in Tehran: opportunities for prevention. Hum Exp Toxicol 2009 Apr;28(4):209-13. https://doi.org/10.1177/0960327108097194

Qureshi MA, Nadeem S, Ahmed T, Tariq F, Rehman H, Qasim AP. Aluminium phosphide poisoning: clinical profile and outcome of patients admitted in a tertiary care hospital. Annals Punjab Med Coll 2018;12(3):191-4.

Soltaninejad K, Nelson LS, Bahreini SA, Shadnia S. Fatal aluminum phosphide poisoning in Tehran-Iran from 2007 to 2010. Indian J Med Sci 2012 Mar-Apr;66(3-4):66-70. https://doi.org/10.4103/0019-5359.110909

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 May 27;40:e2018022. https://doi.org/10.4178/epih.e2018022




DOI: https://doi.org/10.46903/gjms/19.01.931

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