Study of the Causes of Mortality in Acute Aluminium Phosphide Poisoning

Aluminum phosphide (ALP) poisoning has aroused interest in the past three decades. The percentage of poisoning is low, but the mortality is high and no effective antidote available. The objective of this study was to find out predictors of mortality for patients with acute aluminium phosphide poisoning. All patients with acute aluminium phosphide poisoning admitted to Poisoning Control Center, Ain Shams University Hospital between the years 2015 to 2017 were prospectively studied and compared between survival and non survivor patients. Data collected include demographic data, clinical manifestations, laboratory parameters, ECG and treatment offered to the patients. A total 31 patients were enrolled comprising 20 males and 11 females, 84% were suicide and mortality rate was 35%. Shock and cardiac arrhythmia were observed in 52% and39% respectively, while 26% presented with coma. Abnormal blood sugar and metabolic acidosis were found in 19% and 45% respectively. Fifty two percent of the patients needed inotropic therapy and 32% received N-acetylcysteine (NAC). Risk factors increasing mortality were found as shock, tachycardia, coma, metabolic acidosis, hyperglycemia, cardiac arrhythmia and the need for inotropic drug therapy. The study concluded that aluminum phosphide is a low-cost highly-toxic rodenticide. The circulatory collapse, metabolic acidosis and cardiac arrhythmia are the major causes of death. The role of NAC must be reassessed in larger scale. So, intensive observation in ICU and aggressive symptomatic management should be urgently taken into consideration.