Role of Aggressive Management on Outcome in Patients of Acute Aluminium Phosphide Poisoning

Abstract

Aluminium phosphide poisoning is a common medical emergency in the Northern parts of India and South-East Asian nations. This poison is known to have high mortality ranging from 50% to 90% at various medical centres. In the absence of an antidote, an aggressive management is the need of the hour for reducing the mortality. A retrospective analysis of a set of variables was conducted on a group of 25 patients, followed by a prospective study of the same variables on a group of 25 consecutive patients who were enrolled into the study. Both the groups differed from each other principally in terms of management. The outcome of the management in both the groups were studied and analysed statistically. Factors strongly associated with mortality were consumption of fresh tablets, duration between consumption and treatment, low Glasgow coma scale (GCS), low mean arterial pressure (MAP) and metabolic acidosis. The group managed aggressively had lesser mortality rates than the group managed conservatively. Aggressive treatment benefitted even those individuals in whom prognostic variables were adverse. Aggressive management consisting of thorough gastric lavage, good fluid management, correction of metabolic acidosis, administration of magnesium sulphate, hydrocortisone and vitamin C has reduced the mortality rates in acute aluminium phosphide poisoning.