Aluminum Phosphide Poisoning Research Articles

Potential Clinical and Laboratory Prognostic Factors for Prediction of Need for ICU admission in Acute Aluminum Phosphide Poisoning

Background: Aluminum phosphide (AlP) is a type of fumigant which became a leading factor for suicidal poisoning in developing countries. In the absence of specific antidote, acute aluminum phosphide poisoning is considered a major public health problem. Determination of prognosis is a major concern for clinical toxicologists. Prognostic factors facilitate appropriate disposition to limited intensive care unit (ICU) beds. Aim: The aim of this study was to determine the impact of clinical and laboratory findings for prediction of need for intensive care unit admission in acute aluminum phosphide poisoning. Patients and methods: This cross sectional study was conducted on 114 acute aluminum phosphide poisoned patients admitted to Tanta University Poison Control Center (TUPCC) from May 2017 to November 2019. For these patients characteristic clinical manifestations, laboratory investigations and outcome were recorded. Results: Acute aluminum phosphide poisoned patients who required ICU admission represented 69.3% of cases and 91.1% of all cases died. A significant difference was recorded between patients who needed and those who didn’t need ICU admission as regard Glasgow Coma Scale (GCS), pulse, random blood sugar, pH, HCO3 and serum potassium. Moreover, respiratory rate, oxygen saturation, systolic blood pressure and serum Na were found to be good predictors for ICU admission need in acute aluminum phosphide poisoned patients. Conclusion: Respiratory rate, oxygen saturation, systolic blood pressure and serum Na can predict need for ICU admission in acute aluminum phosphide poisoned patients.

The Prognostic Factors of Aluminum Phosphide Poisoning in Urmia: A-five-years Cross-sectional Study

Background: Aluminum phosphide is a highly toxic fungicide. It causes such severe adverse effects as cardiac arrhythmias, metabolic acidosis, acute renal failure, shock, and even death. Therefore, this study investigated the prognostic factors of aluminum phosphide poisoning. Methods: In this cross-sectional study, all hospitalized patients due to aluminum phosphide poisoning admitted to the poisoning center at Taleghani Hospital, Urmia City, Iran, from 2015 to 2019 were evaluated. The demographics characteristics, clinical findings, and laboratory profiles were retrospectively studied by an investigator-made checklist and evaluated concerning the explored patients’ treatment outcomes. Then, the obtained data were analyzed by descriptive and analytical statistics using SPSS V. 16. Results: The present study investigated 134 patients (96 males & 38 females). The mortality rate was equal to 29.8% (22.4% males & 7.4% females) in the study patients. The research patients’ Mean±SD age was 28.6±11.5) years. The Mean±SD ingestion amount of aluminum phosphide was 1.48±1.06 g (min=0.2 g, max=15 g). Nausea and vomiting with 119 (88.8%), hypotension: 89 (66.4%), vertigo: 80 (59.7%), and sinus tachycardia: 74 (55.2%) were the most signs and symptoms in the study patients, respectively. Statistically significant relationships (P<0.05) were found between the patients’ treatment outcomes and white blood cells, direct bilirubin, Hco3, base excess, magnesium, Aspartate Aminotransferase, Alanine Aminotransferase, Blood Urea Nitrogen, creatinine, blood glucose, pH, prothrombin time, and the international normalized ratio. Furthermore, significant relationships were detected between the patients’ treatment outcomes and leukocytosis, hypokalemia, hyperglycemia, and hypoglycemia (P<0.05). Conclusion: Such prognostic factors as demographics characteristics, clinical findings, laboratory profiles, and electrolytes could be used as good indices of the severity of toxicity in patients; accordingly, such data are beneficial for the proper management of patients by healthcare providers. Therefore, prognostic factors should be considered in the diagnosis, treatment, and follow-up stages for these patients.

Cardiovascular Conditions in Patients With Aluminum Phosphide Poisoning

Background: Aluminum Phosphide (AlP) is a well-known rodenticide and insecticide, used as a fumigant to control pests and rodents in grain-storage facilities. Its intoxication presents a medical emergency that requires early rigorous management. This study aimed to investigate cardiac function by Electrocardiogram (ECG) changes in patients with AlP intoxication. We also explored the potential relationship between low bicarbonate and cardiac function. Methods: This cross-sectional study investigated 42 patients in the age range of 17-47 years, with a history of orally-administered AlP poisoning, known as “rice tablet”, admitted to the toxicology ward of Imam Reza Hospital from March 2019 to March 2021. The study patients’ demographic data were collected by trained interviewers, using pretested questionnaires. Systolic and diastolic blood pressure, as well as blood samples, were measured 12 hours from admission. Echocardiography was performed during the first 12 hours and on the fifth-day post-admission. All statistical analysis was performed using R 3.6.1. The significance level was set at 0.05 for all statistical tests. Results: In total, 48.78% of patients presented normal bicarbonate levels, and 24.39% and 26.83% had moderate and severe acidity, respectively. Moderately and severely decreased Left Ventricular Ejection Fraction (LVEF) was observed among 21 (51.2%) and 10 (24.4%) patients, respectively. Furthermore, mild Right Ventricular (RV) function was observed among 11 (26.8%) patients. A statistically significant association was observed between bicarbonate level and RV function (P<0.001) and LVEF (P<0.001). Besides, 19.5% of the explored patients expired. The proportion of expired patients was significantly higher in patients with mild RV function, compared to the other patients (P<0.001). Conclusion: Acute AlP intoxication is a worldwide serious problem. Severe metabolic acidosis and ECG abnormalities are associated with poor outcomes in this respect. Thus, conducting early ECG and echocardiography could be desirable instruments to predict prognosis. There is no antidote for AlP poisoning; thus, the replacement of a safer agent for in-store grain protection is strongly suggested.

Successful Treatment of Acute Aluminum Phosphide Poisoning by Aloe Vera Syrup: A Case Report

Background: Aluminum phosphide, known as rice pill in Iran, is a very effective pesticide for commercial and industrial ‎use. The high lethality of Aluminum phosphide is due to Phosphine gas (PH3) which is released by its ‎reaction with water. One of the most important properties of aluminum phosphide, which despite being ‎very lethal to almost all living creatures, still makes it one of the most widely used pesticides, is its very ‎high yield, ease of use, and, most importantly, the absence of residues in products after application; while ‎its exposure to the human body is associated with high mortality.‎ Case Presentation: In this article, we reported the successful treatment of rice pill-induced poisoning in a 30-year-old man using a novel approach. Accordingly, we used sodium bicarbonate (50 ccs) and aloe vera syrup (1-2 L), followed by olive oil (150 cc olive oil was given every 2 hours). Conclusion: While numerous studies recommend observing patient conditions as the treatment approach, our presented case was a successful experience of treating acute aluminum phosphide poisoning.

English

Aluminium phosphide (ALP) is a widely available pesticide. It is highly toxic when ingested, and can lead to refractory hypotension, acute respiratory distress syndrome (ARDS) and fatal arrhythmias.1 Management of aluminium phosphide toxicity is mainly supportive due to the fact that there is no specific antidote, so mortality with aluminium phosphide poisoning is very high, ranging from 37 % to 100 %.

Malondialdehyde and Total Antioxidant Capacity as Predictors Biomarkers of Mortality in Acute Aluminium Phosphide Poisoning

Introduction: Aluminum Phosphide “ALP” tablets are frequently used to commit suicide in developing countries and Egypt. Mortality is very high; it can induce oxidative stress and alter antioxidant defense system. Aim of the Work: This study aimed to evaluate malondialdehyde “MDA” and total antioxidant capacity “TAC” as oxidative stress biomarkers in acute ALP poisoning and correlated them with poisoned patients’ outcome and mortality. Subjects and Methods: This study was conducted on 120 individuals of both sexes divided into; (Group I) included 60 acute ALP poisoning patients, presented within 6 hours of exposure to Toxicology Unit of Emergency Hospital, Mansoura University and the remaining 60 (Group II) were healthy individuals as control group. Results: Serum level of MDA was significantly increased, and TAC was significantly reduced in ALP poisoned group at time of presentation in comparison to control group. On the other hand, levels of MDA and TAC were statistically significant difference between survivors and expired groups. In addition, serum MDA and TAC were found to be sensitive in prediction of ALP mortality. However, MDA level showed maximum specificity as well as more accuracy for prediction of poor outcomes. Conclusions: It can be concluded that, ALP exerts its toxicity through developing disproportionate oxidative stress and compromising antioxidant protective mechanisms. Both MDA and TAC were sensitive in prediction of ALP mortality and serum MDA level could be used as a more sensitive specific predictor biomarker for poor prognosis in acute ALP poisoning.

Clinical Profile and Treatment Outcome of Aluminum Phosphide Poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: A Retrospective Study.

BackgroundAluminum phosphide (AlP) is an effective fumigant and rodenticide which is a commonly used agent for self-poisoning in parts of Ethiopia. AlP poisoning results in serious manifestations involving many vital organs and it has high mortality. Despite its high incidence and mortality, studies on AlP poisoning in Ethiopia are lacking. Our objective was to study the clinical profile and treatment outcome of AlP poisoning in Felege Hiwot Referral Hospital (FHRH), a major referral hospital in Ethiopia.MethodsIt is a retrospective study conducted over all consecutive AlP poisoning cases who presented to the emergency department (ED) of the hospital from March 2018 to August 2020. A questionnaire was used to collect data from patient medical records. All data were analyzed using SPSS 25.ResultsA total of 125 patients were studied. Females were 57.6% and males were 42.4%. Age of patients ranged from 12 to 60 with mean age 28.5 years. The average number of AlP tablets taken was 1.2 (3.6 gm) and the average time of arrival to hospital after AlP ingestion was 4.8 hours. Nausea and vomiting were the commonest presenting features seen in 74.4% of the cases followed by hypotension which was seen in half of the cases. A wide range of laboratory findings and complications were also observed. Cases of AlP poisoning with hypotension were managed in the ICU with dopamine infusion, magnesium sulphate, hydrocortisone, and calcium gluconate in addition to gastric lavage and fluid administration. Those cases without hypotension were managed with gastric lavage and maintenance fluid only. Overall mortality from AlP poisoning was 31.2%.ConclusionWith a treatment protocol used in FHRH, mortality from AlP poisoning was 31.2%. Using this protocol in resource limited settings might give opportunities to reduce mortality from AlP poisoning.

Changing Trends (Patterns) of Human Poisoning in Kadapa Region – a Five Years Study

“Caution is advised while decontaminating a victim of poisoning. Over enthusiasm may result in the patient, not the poison” – John Morrision Poisoning has been known to mankind since time immemorial and the study of various poisons and their effects has always fascinated mankind. References to poisons and various instances of poisoning are available in Indian Shastras, Egyptian Papyari and Sumerian writings.1Since then many substances considered advantages and disadvantages in the form of food or poisons have been discovered. Those substances which are used unfortunately to take away the man’s life or cause ill health have been changing. Some of the great persons who were poisoned to death are Chatrapati Shivaji Maharaj,2-3 whose bed was poisoned, Socrates, who was made to drink Hemlock (Conium maculatum) and Rasputin who was poisoned with cyanide and then shot. Aluminum phosphide poisoning, a rodenticide is also posing a formidable challenge and is on the way for taking the number one position. As poisoning trends go on changing, it is necessary to know the poisoning trends from time to time.

Variation of insect succession in summer on decomposing rabbit carrions treated with aluminum phosphide in Beheira governorate, Egypt

The present study aimed to record the arthropod fauna of medico-legal importance in an urban city: El Delengat, Beheira governorate, Egypt, by studying the succession of insects and the duration of the decomposition of rabbit carrions injected with Aluminum phosphide (AlP). In our study the total of twelve male rabbits, Oryctolagus cuniculus L, each weighing 1,25 kg were used. The experiment was conducted in summer. Three replicate experiments were conducted, for each experiment, 3 rabbits were administered intragastrically dosages of 27.4 mg, 13.7 mg, 54.8 mg of aluminum phosphide by body weight representing LD50, ½ LD50, 2 LD50, respectively. The fourth rabbit was used as a control, injected by saline solution. The recorded entomofauna was denoted in 5 orders, 12 families, and 17 genera and species. Necrophagous arthropods that colonized rabbit carrions were substantially of Diptera and Coleoptera orders. Calliphorid insects was the foremost family that colonizing the different carrions. AlP appeared to delay the decomposition process in ½ LD50 and 2 LD50 carrions. These results are the primary record of the arthropod successive pattern on aluminum phosphide remains, it will provide useful data in any future case studies involving AlP intoxication.

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

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%.

Study of the cardioprotective effects of crocin on Human Cardiac Myocyte cells and reduction of oxidative stress produced by aluminum phosphide poisoning.

The effects of Crocin as a cardioprotective material against Aluminum phosphide poisoning by reducing the oxidative stress is investigated. The level of biomarkers of oxidative stress (Catalase, Superoxide dismutase, Malondialdehyde and Protein carbonyl) were measured in the cell culture model on Human Cardiac Myocyte cells to detect the protective effect of crocin. Initially, to define the pure impact of aluminum phosphide poison and crocin on the heart cells, their effects on the biomarkers quantity in cell line were measured, separately, using the standard related kits. Later the effect of crocin with different concentration as a treatment on the oxidative stress biomarkers of the poisoned heart cells were monitored. Note that in pre-treatment case, the crocin was initially added to the cells before poisoning them. Data were analyzed using the analysis of variance method. Results showed that crocin treatment reduced the aluminum phosphide (AlP) poisoning effect significantly. The treatment resulted in substantial deviation in the biomarkers of oxidative stress at the pre- and post-treatment phases for all groups. The oxidative markers values of the poisoned cells were recovered by crocin treatment. Crocin is proposed as a potentially powerful antioxidant to treat the cardiotoxicity caused by aluminum phosphide poisoning.

Validation of Corrected and Dispersed QT as Predictors of Adverse Outcomes in Acute Cardiotoxicities.

Acute cardiovascular poisoning is a major cause of adverse outcomes in poisoning emergencies. The prognostic validity of corrected QT (QTc) and dispersed QT (QTd) in these outcomes is still limited. The present study aimed to determine the risk factors of mortality, adverse cardiovascular events (ACVE), and intensive care unit (ICU) admission in patients with acute cardiovascular toxicities and assess the validity of QTc and QTd intervals in predicting these outcomes. This study was conducted on adult patients admitted to Tanta University Poison Control Center with a history of acute cardiotoxic drugs or toxins exposure. The demographic and toxicological data of patients were recorded. Clinical examination, routine laboratory investigations, ECG grading, and measurement of QTc and QTd were performed. The patients were grouped according to their adverse outcomes. Among the included patients, 51 (31.48%) patients died, 61 (37.65%) patients had ACVE, and 68 (41.98%) patients required ICU admission. The most common cause of poisoning is aluminum phosphide, followed by cholinesterase inhibitors. QTd and QTdc showed no significant difference among outcome groups. The best cut-off values of QTc to predict mortality, ACVE, and ICU admission were > 491.1ms, > 497.9ms, and ≥ 491.9ms, respectively. The derived cut-off QTc values were independent predictors for all adverse outcomes after adjusting for poison type, serum HCO3, and pulse. The highest odds ratios for all adverse outcomes were observed in aluminum phosphide poisoning and low HCO3 < 18mmol/L. Thus, serum HCO3 and QTc interval should be monitored for acute cardiotoxicities, especially in aluminum phosphide and cholinesterase inhibitors poisoning.

Clinical Spectrum and Severity of Poisoning in the Paediatric Intensive Care Unit of a Tertiary Care Centre in Uttarakhand: A Retrospective Cohort Study

Introduction: Acute poisoning causes significant mortality and morbidity among children worldwide. However, the pattern of poisoning and causative substances varies significantly in geo- demographic areas. Aim: To describe admissions due to acute poisoning in the Paediatric Intensive Care Unit (PICU) of a tertiary care centre in terms of demographics, clinical profile, specific agents involved and severity of poisoning. Materials and Methods: This was a retrospective cohort study conducted in PICU of a tertiary care level teaching institute of Uttarakhand, India, over a period of three years on subjects of age group from one month to 18 years. Data was collected and analysed for demography, clinical presentation, substance, management, complications, and outcome. Poison Severity Score (PSS) was used to assess the severity of poisoning. Data was analysed using Statistical Package for the Social sciences (SPSS) software version 21.0. Results: During the study period, out of total 751 PICU admissions, 45 were due to poisoning. Organophosphates 20 (44%) and aluminium phosphide 12 (26%) were the most common substances used. Accidental poisoning was common 6 (46%) among less than five years of age. However, suicidal attempts were noted more frequently 20 (64%) among &gt;15 years of age group. Vomiting 31 (69%), altered sensorium 23 (51%), and pain abdomen 16 (35%) were the most common presentations. Nine (20%) patients required ventilatory support as well. Three (6.6%) patients died; all associated with aluminium phosphide poisoning. Conclusion: The most common poison consumed is organophosphate. Aluminium phosphide is the most lethal poison, accounting for all the deaths in the study. Accidental poisoning is common in children less than five years of age. Suicidal poisoning is common among adolescents which must be prevented by early detection of stress. Primary health care facility hesitates to intervene even for basic poisoning care before referring.

Investigating the Outcomes of Aluminum Phosphide Poisoning in Khorshid Referral Hospital, Isfahan, Iran: A Retrospective Study.

Objective:Aluminum phosphide (ALP) (rice-tablet) is a common cause of adult poisoning in Iran, including Isfahan. So far, no effective treatment has been identified for this poisoning. We aimed to investigate the outcome of ALP poisoned patients admitted to the clinical toxicology ward of Khorshid Hospital in Isfahan from 2017 to 2019.Methods:This chart-review study was performed on the population of ALP poisoned patients admitted to the clinical toxicology ward of Khorshid University Hospital from 2017 to 2019 treated with the hospital’s new treatment protocol, using the complete enumeration approach. The outcomes were determined by reviewing and abstracting medical charts of ALP poisoned patients from the hospital archive.Findings:The most common complaints at admission were depressed consciousness (41.9%) and vomiting (32.2%). There was no significant change in blood sugar, pH, base excess (BE), and venous blood bicarbonate throughout their hospitalization (P > 0.05). Treatment outcomes had a significant relationship with blood pH 2 h and 6 h after admission and the BE 6 h after admission (P < 0.05). There was also a significant relationship between the outcome and the length of stay, initial ejection fraction (EF), and EF in predischarge echocardiography (P < 0.05). Out of 31 patients, 24 (77.4%) died within 72 h, 5 (16.1%) recovered without any complication, and 2 (6.5%) recovered with some complications.Conclusion:The mortality rate of ALP poisoned patients was reasonably high and can be attributed to the poor efficacy of the new treatment protocol or the long time it takes for patients to reach the hospital and start receiving treatments.

Successful Management of an Aluminum Phosphide Poisoned Patient Following Ventricular Tachycardia

Aluminum Phosphide (ALP) poisoning is regarded as fatal; however, it is commonly used in developing countries. In some countries, such as India and Iran, it is still being used to protect grain against pests at home. As yet, no known antidote is reported to be effective against ALP poisoning. ALP acts through blockage of cell respiration, alteration of cell permeability, and induction of oxidative stress. Some factors can worsen the prognosis of its intoxication, which include hyperglycemia on admission, ingestion of fresh tablets, cardiac abnormality, especially Ventricular Tachycardia (VT), severe metabolic acidosis, cardiogenic shock and other types of shocks, electrolyte disturbances, end-organ damage, and a need for mechanical ventilation. ALP kills its victims by induction of multi-organ failure. In this study, we controlled the patient’s VT using MgSO4, electric shock, amiodarone, and lidocaine. We also encountered the cardiogenic shock using norepinephrine, High-Dose Insulin (HDI), antioxidants, sodium bicarbonate, and normal saline. Moreover, myocardial ischemia, recurrent VTs, and adverse cardiac effects were protected via tight control of magnesium and other electrolytes.

The Pivotal Role Of Coconut Oil Or Liquid Paraffin As Antidote Effective In Reducing Acute Aluminum Phosphide Poisoning In Cardiogenic Shock

Abstract Introduction/Objective Aluminum phosphide (Alp) is a self-poisoning agent for raising the mortality rates in developing countries. Alp is known as “Rice-tablet” which is a cheap solid fumigant pesticide that is used for grain preservation which becomes a common mode of suicidal attempts in the rural community in Egypt. This study aims to identify the mechanism of salient features and management strategies were carried out on acute Alp-poisoned patients at Poison-Emergency-Unit, ElBehira-Hospitals. That was performed between Jan2018-Jun2019. Methods Patients were subjected to a full history evaluation of age, sex, Blood gases, and ECG, were demonstrated. Patients were grouped according to their outcome into survivors and non-survivors groups. Results The results demonstrated that (93%) of Alp-poisoning cases by oral-ingestion as suicidal attempts which were (54%) survived while (46%) non-survived. The blood-gases were showed that over 50% of the cases had metabolic acidosis with a highly-significant difference between survivors and non-survivors. PH and HCO3 values were significantly lower in non-survivors than those in the survivor group. Furthermore, SaO2 value was significantly higher in survivors than that of non-survivors. So the managing Alp-poisoning should be started for first 6hr since exposure. Treatment includes early gastric lavage with potassium-permanganate-(1:10,000), sodium-bicarbonate or coconut-oil/liquid-paraffin. The mechanism of Alp-poisoning explained that, phosphine gas inhibits 70% of mitochondrial cytochrome-c-oxidase in myocardial-tissue by the effect of free-radicals; electrolyte disturbance, and intracellular acidosis all cause a reduction in cardiac function, and multi-organ damage. These effects may cause arrhythmia and myocarditis which may be the cause of death. Conclusion It was concluded that myocardial depression with shock and metabolic acidosis may lead to respiratory failure due to acute Alp-poisoning. This case study reported that coconut oil play a pivotal role in managing acute Alp- poisoning even 6h post ingestion for reducing the oxidative outcomes of phosphine and recommended as antidote for acute Alp-intoxication.

Pattern of Poisoning Cases at Tertiary Care Center at Geetanjali Medical College &amp; Hospital, Udaipur

Introduction: Poisoning is a global public health problem causing significant morbidity and mortality. Itis important to know the pattern and outcome of acute poisoning cases for proper planning, prevention andmanagement of these cases.Aims and Objective: To find out the pattern of poisoning reported in Geetanjali Medical College, Udaipur.Material and Methodology: The present prospective study had been conducted in the Department ofForensic Medicine, Geetanjali Medical College &amp; Hospital, Udaipur, Rajasthan during the period of Twoyear from 1st Jan 2017 to 31th Dec 2018.Result and Observation: In our study majority of poisoning case [101 cases (35.69%)] were observed inthe age group of 21-30 years followed by the age group of 11-20 years. Male person [153 cases (54.06%)]most commonly affected by poison and majority of patients [184 cases (65.02%)] belongs to Rural area.In our study majority numbers of cases [128 cases (43.82%)] found in rainy season. In our studyhighernumber of poisoning cases were due to Aluminium phosphide poisoning [106 cases (37.47%)] followedby snakebite poisoning [62 cases (21.91 %)]. Among insecticides, maximum 40 cases (14.13 %) were dueto Organophosphorus compounds. Conclusion:Awareness and education about the potential toxicity ofcommonly used pesticides and drugs may help in reducing the burden of poisoning

&amp;ldquo;PGI Score&amp;rdquo;: A Simplified Three-point Prognostic Score for Acute Aluminum Phosphide Poisoning

IntroductionAluminum phosphide (AlP) ingestion for self-harm is associated with a high case-fatality rate (CFR) in low- and middle-income countries. A reliable and accurate prognostic scoring tool is required for appropriate triaging, to guide clinical decision-making, and to evaluate the efficacy of therapeutic interventions for the patients with AlP toxicity.Materials and methodsWe performed a prospective cohort study in a tertiary care hospital in north India in patients aged 15 years and over with acute AlP poisoning, investigating the parameters associated with CFR, and developing a reliable and simple prediction score.ResultsThe CFR was 51% in this cohort of 105 patients. Three parameters—pH <7.25, score on Glasgow coma scale (GCS) <13, and systolic blood pressure (SBP) <87 mm Hg were most robust predictors of CFR (odds ratio; 12.614, 18.621, and 17.600, respectively; area under the receiver operating characteristic curve—0.808, 0.796, and 0.776, respectively). Based on these parameters (with 1 point to each), a prognostic score was developed, ranging from 0 to 3 points. A total score of 3 had a 98.2% specificity and a positive predictive value of 96.4%, whereas a score ≤1 had a 100% sensitivity and 100% negative predictive value.ConclusionA scoring system based on low pH (P), low GCS score (G), and impaired or low SBP (I) (“PGI” score) may provide a simplified predictive model for mortality in AlP poisoning.How to cite this articlePannu AK, Bhalla A, Sharma A, Sharma N. “PGI Score”: A Simplified Three-point Prognostic Score for Acute Aluminum Phosphide Poisoning. Indian J Crit Care Med 2020;24(9):790–793.

TO FIND OUT ELECTRO-CARDIOGRAPHIC CHANGES & ECHO CHANGES IN ALUMINIUM PHOSPHIDE AND ETHYLENE DIBROMIDE POISONING

Background &amp; Method: The study was conducted in the Department of Medicine Shyam Shah Medical College and Associated Sanjay Gandhi Memorial Hospital, Rewa (M.P). History was followed by a careful clinical examination i.e. cardiovascular, respiratory and gastrointestinal and nervous system. Investigations had done included routine haematological examination, Biochemical analysis, urine examination, ECG, 2 D. Echo &amp; Histopathological examination was done.&#x0D; Result: ST-T changes were most common finding in Aluminium phosphide poisoning in relation to mortality. However hyperkalemia was the most ominous finding associated with 100% mortality, ECG finding in EDB was normal ECG. The most ominous finding was arrhythmia which was associated with 100% mortality. Survivors of ethylene dibromide poisoning echocardiography was normal in 11 (84.61%) followed by pericardial effusion in 2 (15.38%) patients.&#x0D; Conclusion: Noteworthy finding was absence of correlation between cardiovascular involvement, histopathological changes and ECG findings. It was seen that even if ECG showed normal pattern there were significant histopathological changes in heart.&#x0D; Keywords: electro-cardiographic, Aluminium phosphide, ethylene dibromide &amp; poisoning.

Total Gastric Necrosis as a Presentation of Aluminum Phosphide Poisoning: A Case Report

Background: Rice pill poisoning is among the most frequent causes of death among prisoners. Despite advances in the treatment of this poisoning, its mortality rate remains high. The symptoms of Aluminum Phosphide (AlP) poisoning are varied and progressive. One of the essential foundations of diagnosis is based on the history of swallowing the pill by the patient or their companions.&#x0D; Case report: A 20-year-old woman with generalized abdominal pain and a diagnosis of peritonitis was operated. The operative finding was total gastric necrosis. After the operation, the patient's husband claimed that she had consumed some rice pills, intending to commit suicide. Despite all efforts, she remained in persistent septic shock and multi-organ failure and passed away after surgery.&#x0D; Conclusion: Total gastric necrosis could be among the lethal complications of rice tablet (AlP) poisoning.