Phosphide Poisoning

ABSTRACT

Objective: To determine the factors predicting mortality in patients with aluminium phosphide poisoning.

Study Design: Retrospective study.

Place and Duration of Study: The study was carried out at the Department of medicine, Combined Military Hospital, Kharian from 1st July 2013 to 30 December 2014.

Methodology: We enrolled 56 patients in the study by consecutive sampling. The diagnosis of wheat pill poisoning was based on history of consumption of the poison and symptoms at time of presentation. End point of study was death and discharge from the hospital. Severity assessment was done using APACHE II (Acute Physiology and Chronic Health Evaluation) and SAPS II (Simplified Acute Physiology Score). All the data was recorded on

We enrolled 56 patients in the study by consecutive sampling irrespective of age and sex. The diagnosis of wheat pill poisoning was based on history of consumption of the poison (obtained from the patient or the closest relative) and symptoms (nausea, vomiting, epigastric pain, metabolic acidosis, refractory hypotension) at time of presentation. Patients with pre-existing medical illness, doubtful history of poisoning or those who have consumed more than 1 poison were excluded from the study. Patients with diagnosis of wheat pill poisoning were given initial resuscitation at medical reception centre. Patient's blood pressure, pulse, temperature, oxygen saturation, respiratory rate and urine output was measured in all patients. High flow oxygen, intravenous access, electrocardiographic recording were immediately obtained. Gastric lavage was started immediately and done using 3 litres of normal saline in all cases. Patients were admitted to intensive care unit and baseline blood samples for biochemical and haematological investigations were sent within an hour of presentation to the hospital. Symptomatic treatment was given on individual basis for metabolic acidosis, vomiting, hypotension. Sodium bicarbonate was used for metabolic acidosis, Metoclopramide or Ondansteron for vomiting and infusion with dopamine and dobutamine were given to correct

Mortality rate found in our study was 86% which is also concordant with other international studies4. Survival is found unlikely in our study if ingested dose was more than 1.5 grams of aluminum phosphide which is also compatible with other studies14. The mortality rate was significantly higher in our study in patients with increase number of tablets intake, late reporting to hospital and ingestion of unexposed tablets. Above mentioned variables have a strong effect on clinical presentation and outcome of the poisoning as evidenced by various studies13,16. Seven variables of our study including delayed presentation , presence of hypotension, high serum creatinine, low bicarbonate, low PH, high APACHE II and SAPS II scores at time of admission in hospital were associated with higher mortality and relation was highly significant statistically( p value<0.05). APACHE II and SAPS II are one of the several ICU (Intensive Care Units) scoring systems designed to measure the severity of the disease in patients admitted to ICUs. Hajouji I et al17 evaluated the efficacy of APACHE II and SAPS II to determine the severity of aluminum phosphate poisoning and found that they were positively