N-acetylcysteine as an Adjuvant in The Treatment of Acute Aluminum Phosphide Poisoning: A Randomized Clinical Trial

Abstract

Aluminum phosphide (ALP) is a common pesticide used for agricultural and non-agricultural purposes. Being cheap, widely available and highly toxic, it is responsible for many cases of poisoning. Aluminum phosphide poisoning has no specific antidote, therefore, based on role of oxidative stress in ALP poisoning, N-acetylcysteine (NAC) was suggested as adjuvant therapy in acute ALP poisoning.This study is a randomized clinical trial. It was conducted in Poison Control Center (Emergency Hospital, Tanta University). Thirty acute ALP intoxicated patients were randomly allocated into two equal groups A and B using the sequentially numbered, opaque sealed envelopes method. Group Areceived NAC 140 mg/Kg IV infusion as a loading dose followed by 70 mg/KgIV infusion every 4 hours up to 17 doses in addition to the routine treatment. Group B received only the routine treatment. Complete physical examination, routine laboratory investigations and oxidative stress markers; Malondialdehyde (MDA) and total antioxidant capacity (TAC) were performed for each patient.Results of the current study revealed no statistical significant difference between group A and group B patients regarding sociodemographic, toxicologicaland clinical data as well as routine laboratory investigation. On admission, MDA and TAC serum levels showed no statistical significant difference between group A and B. After treatment a statistical significant difference was observed in serum MDA and TAC levels between group A and B. Also, significant differenceswere noticed between group A and group B patients concerning mortality, dose of dopamine and hospitalization time.The study concluded that NAC might be a promising adjuvant therapy in treatment of acute ALP toxicity.