Aluminum Phosphide Poisoning Research Articles

Outcome of Patients with Acute Aluminium Phosphide Poisoning In a Tertiary Care Hospital of Haryana

Background: The only factor that determines the severity and monitors the progress of cases of AIP poisoning is blood phosphine level. The mortality is highly variable depending on the freshness and dose of the compound consumed. The present study has been designed to determine the serial levels of phosphine in blood and to correlate them with outcome of the patients. Materials: Fourty five patients of aluminium phosphide poisoning irrespective of age, sex, dose and duration, admitted in Medical College, Rohtak were studied. The patients were grouped in I,II, IIa, IIb. Data was collected on a semi structured schedule and consent was taken. Appropriate staistical tests were applied. Observations: The blood phosphine levels at admission, at 12 hours and 24 hours in group-I patients were significantly higher than patients of group-II A & B, making the conclusion that group-I patients had severe intoxication and consumed active and fresh compound. In group-II A patients, blood phosphine levels at admission, at 12 hours and 24 hours were significantly lower than group-I but higher than groupII B paitents. This indicated that compound consumed by group-II A patients was still active but less than group-I. These patients had mild intoxication. Introduction Aluminium phosphide (AIP), a solid fumigant pesticide is widely used as a grain preservative in Northen India. It is available in India in tablet form with the brand names of Celphos and Quickphos in air tight container. Each tablet contain 56% aluminium phosphide as an active ingredient and 44% ammonium carbonate and is 3g by weight, has capacity to liberate 1g of phosphine gas on contact with moisture or humidity present in grains or in atmospheric air. Aluminium phosphide is a systemic poison and its toxic effects are due to liberation of toxic phosphine gas in the stomach. The diagnosis of acute aluminium poisoning is based upon (i) history of ingestion of fresh and active compound in the form of tablet which is compact, full of texture, lusture, foul smelling and about 50 paisa coin size. (ii) (ii) Decaying fish or garlic like odour imparted to breath with presence of shock of hypotension. (iii) Positivity of silver nitrate paper test with gastric fluid or with breath www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i8.48

Therapeutic role of hyperinsulinemia/euglycemia in aluminum phosphide poisoning

Background:Different protocols have been suggested to treat aluminum phosphide (ALP) poisoning. We aimed to evaluate the possible therapeutic effect of hyperinsulinemia/euglycemia (HIE) in treatment of ALP poisoning.Methods:In a prospective interventional study, a total of 88 ALP-poisoned patients were included and assigned into HIE group undergoing glucose/insulin/potassium (GIK) protocol and a control group that was managed by routine conventional treatments. The 2 groups were then compared regarding the signs and symptoms of toxicity and their progression, development of complications, and final outcome to detect the possible effect of GIK protocol on the patients’ course of toxicity and outcome.Results:The 2 groups were similar in terms of demographic characteristics and on-arrival vital signs and lab tests. Using GIK protocol resulted in significantly longer hospital stays (24 vs 60 hours; P < 0.001) and better outcomes (72.7% vs 50% mortality; P = 0.03). Regression analysis showed that GIK duration was an independent variable that could prognosticate mortality (odds ratio [95% confidence interval] = 1.045 [1.004,1.087]). The risk of mortality decreased by 4.5% each hour after initiation of GIK.Conclusion:GIK protocol improves the outcome of ALP poisoning and increases the length of hospital stay.

Rice tablet: An overview to common material in Iran

Rice tablets or Aluminum phosphide (ALP) poisoning is one of the most lethal poisoning cases in the country, leading to high mortality, especially in youths every year. The management of aluminum phosphide poisoning remains purely supportive because no specific antidote exists. Although in various studies mortality rates has been reported ranged 40-80%. In many cases it marked too late, suspected to consume of Botanical rice tablets (garlic compound) and caused delay in aggressive treatment. Aluminium phosphide, is an effective insecticide and rodenticide, which is used widely in the storage place and transportation of grain as a fumigant to control rodents and pests. For many years, Aluminum and zinc phosphide have been strong insecticides and rodenticides, which are cheap and effective, and their residues are not toxic

Changing epidemiology of poisoning in Central India: shifting poles from male farmers to young house wives

Introduction: Acute self infliction of poisoning is very common among young in developing countries. The epidemiology of poisoning changes time to time and varies region to region. In south India, organophosphorus compound poisoning has been more common as compared to Aluminium phosphide poisoning in north India. All over India males are more commonly reported to poison themselves. Poisoning in farmers has been reported more commonly than in any other profession. Madhya Pradesh is situated in central part of India, where agriculture is the predominant source of income. There is a knowledge gap in epidemiology of poisoning in this region. Methods: This is a hospital based observational type cross sectional study over nearly 2 years. Results: Out of the 550 number of study participants about 90% were younger than 40 years. Females were more common than males in all age groups. Poisoning was more common in married population in both the genders. House wives followed by unemployed students were the most vulnerable populations. Farmers constituted only about 10% of total cases. Organophosphorus compounds were the most common type of poisoning contributing to almost one fourth of the total cases followed by Zinc phosphide, Aluminium phosphide, oleander and ethylene dibromide poisoning in decreasing order. The overall mortality was 9.8% (n=54). The case fatality rates of various agro-chemicals in decreasing order were Aluminum phosphide (44.7%), ethylene dibromide (17.6%), and organophosphorus (7%). These 3 poisonings contributed to 92.5% of all deaths. Death was more common when the time lag to hospitalization was > 6 hours. Conclusion: Younger age group, female sex and housewives were the most vulnerable group. The case fatality rate of various poisonings in decreasing order were Aluminum phosphide (Celphos) poisoning followed by EDB and OPC.

Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: An observational study

IntroductionAluminum phosphide (AlP) poisoning has a high mortality rate despite intensive care management, primarily because it causes severe myocardial depression and severe acute respiratory distress syndrome. The purpose of this study was to evaluate the impact of the novel use of extracorporeal membrane oxygenation (ECMO), a modified “heart-lung” machine, in a specific subset of AlP poisoning patients who had profound myocardial dysfunction along with either severe metabolic acidosis and/or refractory cardiogenic shock. MethodsBetween January 2011 and September 2014, 83 patients with AlP poisoning were enrolled in this study; 45 patients were classified as high risk. The outcome of the patients who received ECMO (n=15) was compared with that of patients who received conventional treatment (n=30). ResultsIn the high-risk group (n=45), the mortality rate was significantly (p<0.001) lower in patients who received ECMO (33.3%) compared to those who received conventional treatment (86.7%). Compared with the conventional group, the average hospital stay was longer in the ECMO group (p<0.0001). In the ECMO group, non-survivors had a significantly (p=0.01) lower baseline LV ejection fraction (EF) and a significantly longer delay in presentation (p=0.01). ConclusionVeno-arterial ECMO has been shown to improve the short-term survival of patients with AlP poisoning having severe LV myocardial dysfunction. A low baseline LVEF and longer delay in hospital presentation were found to be predictors of mortality even after ECMO usage. Large, adequately controlled and standardized trials with long-term follow-up must be performed to confirm these findings.

Elevated Carboxyhaemoglobin Concentrations by Pulse CO-Oximetry is Associated with Severe Aluminium Phosphide Poisoning.

In pulse CO-oximetry of aluminium phosphide (ALP)-poisoned patients, we discovered that carboxyhaemoglobin (CO-Hb) level was elevated. We aimed to determine whether a higher CO level was detected in patients with severe ALP poisoning and if this could be used as a prognostic factor in these patients. In a prospective case-control study, 96 suspected cases of ALP poisoning were evaluated. In the ALP-poisoned group, demographic characteristics, gastric and exhalation silver nitrate test results, average CO-Hb saturation, methaemoglobin saturation, and blood pressure and blood gas analysis until death/discharge were recorded. Severely poisoned patients were defined as those with systolic blood pressure ≤80 mmHg, pH ≤7.2, or HCO3 ≤15 meq/L or those who died, while patients with minor poisoning were those without any of these signs/symptoms. A control group (37 patients) was taken from other medically ill patients to detect probable effects of hypotension and metabolic acidosis on CO-Hb and methaemoglobin saturations. Of 96 patients, 27 died and 37 fulfilled the criteria for severe poisoning. All patients with carbon monoxide saturation >18% met the criteria to be included in the severe poisoning group and all with a SpCO >25% died. Concerning all significant variables in univariate analysis of severe ALP toxicity, the only significant variable which could independently predict death was carbon monoxide saturation. Due to high mortality rate and need for intensive care support, early prediction of outcome is vital for choosing an appropriate setting (ICU or ordinary ward). CO-oximetry is a good diagnostic and prognostic factor in patients with ALP poisoning even before any clinical evidence of toxicity will develop.

Molecular and biochemical evidence on the protection of cardiomyocytes from phosphine-induced oxidative stress, mitochondrial dysfunction and apoptosis by acetyl-L-carnitine.

The aim of the present study was to investigate the efficacy of acetyl-L-carnitine (ALCAR) on pathologic changes of mitochondrial respiratory chain activity, ATP production, oxidative stress, and cellular apoptosis/necrosis induced by aluminum phosphide (AlP) poisoning. The study groups included: the Sham that received almond oil only; the AlP that received oral LD50 dose of aluminum; the AC-100, AC-200, and AC-300 which received concurrent oral LD50 dose of AlP and single 100, 200, and 300 mg/kg of ALCAR by intraperitoneal injection. After 24 h, the rats were sacrificed; the heart and blood sample were taken for measurement of biochemical and mitochondrial factors. The results specified that ALCAR significantly attenuated the oxidative stress (elevated ROS and plasma iron levels) caused by AlP poisoning. ALCAR also increased the activity of cytochrome oxidase, which in turn amplified ATP production. Furthermore, flow cytometric assays and caspase activity indicated that ALCAR prohibited AlP-induced apoptosis in cardiomyocytes.

A race against time in lethal aluminum phosphide intoxication: a case report

Aluminum phosphide (AP) is a condition that results in death in case of use for suicide purpose. The phosphine gas, which is released as a result of aluminum phosphide intake, has high level of toxicity. It leads to cellular level hypoxia and inhibition of oxidative phosphorylation. Aluminum phosphide intoxication may cause metabolic acidosis, arrhythmia, acute respiratory distress syndrome, and shock. High-dose intakes may lead to death within hours. 22 year-old female patient was taken to our emergency service because of the suicide attempt with 6000mg aluminum phosphide tablet. We aimed to share our experience with our aluminum phosphide intoxication, which has no known antidote and leads to rapid death in follow-up. We aim to present our experiences with our case of intoxication from aluminum phosphide, which causes high mortality after the intake. 22 year-old female patient was transferred to our hospital due to suicide attempt with 6000mg aluminum phosphide tablet. The patients have no known comorbidities, medicine use or allergic history. We believe that, in preventing the high mortality rate in aluminum phosphide intoxication, metabolic acidosis, arrhythmia, ARDS and measures against the shock and the hemodialysis in early period should be performed. Although its efficiency has not been clearly proved and its use has not entered into algorithms, the use of MgSO4 and N-Acetyl-Cysteine in supportive care is an option for such cases. Further studies and proven treatment methods are needed in AP toxicity.

Pattern of Acute Poisoning Cases Admitted to Menoufia Poisoning and Addiction Control Center: A Prospective Study

Introduction: Poisoning is a growing public concern and real potential threat to the Egyptian community. Acute poisoning is a common medical emergency encountered in practice. The knowledge profile of poisoning cases encountered in a particular area is useful to prepare health care professionals to handle these emergencies efficiently Aim of the study is to highlight the pattern of acute poisoning cases in poisoning and control center of Menofia University hospital in order to take appropriate management of these cases. Subjects and methods: a hospital based prospective study carried out on 653 acute poisoning cases admitted to Poisoning and Addiction Control Center at Menoufia University Hospital during the period from the 1st of March to the end of June 2015. Information was obtained from direct interview with patients, their relatives and the attending medical staff at the center after management of the patient as well as from the health records. Personal data, circumstances, type of poisonous substance and outcome were collected. Results: Overall, 653 poison exposure cases were recorded. Children under 7 years old were involved in 40.1% of cases. In 84.4%% of cases, the poisoning was accidental. Attempted suicide was definitely more common in females (83.3%) and the more prevalent age group was from 15-25 years (59.8%). Substances most frequently involved were insecticides (30.4%), drugs (25.4%) especially tramadol and corrosives (11.2%). Most cases (83.0% ) improved. Twenty fatalities were mainly from zinc and aluminum phosphide poisoning . Conclusions and recommendations: Poisoning is more prevalent in children and young adolescents by volatiles, insecticides and drugs this necessitates keeping of poisonous substances out reach of children, restriction in free sale of the poisonous substances. Also, promotion of Poison Information Centers along with public awareness could be suggested to decrease the incidence and mortality of poisoning cases

Cardiovascular profile of aluminium phosphide poisoning and its clinical significance

Background: Aluminium phosphide is a solid fumigant pesticide and it has currently aroused interest with increasing number of poisoning cases in past three decades. Over the time it has become an effective and widely used medium for suicide and homicide. Aluminium phosphide has highly effective killing power. Death is due to its direct toxic effect over the heart leading to peripheral circulatory failure .Aluminium phosphide poisoning affects the most of the organs. Early symptoms include nausea, vomiting, retrosternal and epigastric pain, dyspnea, anxious, agitation and smell of garlic breath. Methods: 50 patients, who were admitted in MICU, following consumption of aluminium phosphide tablets were included in the study. Patient’s clinical evaluation was done as per standard. PaO 2 was noted with pulse oxymeter. Troponin I, ECG and echo of the patients was done to study the cardiac toxicities and pathological reports were correlated. Results: Out of 50 cases, ECG was normal in 20 cases and abnormal in 30 cases-sinus tachycardia was most common finding (24%) while heart block was least (4%). On echo, hypokinesia was seen in 40% cases, decreased ejection fraction in 8% cases and normal echo was seen in 12% cases. Serum troponin test was positive in 26%. Out of 50 cases, 19 died and rest 31 cases survived. Conclusions: AgNO 3 test, ECG and pulse oxymetry are bed side, cost effective tools and should be done in all cases. Echocardiography is a useful tool to evaluate cardiac function and cardiac anatomy. Whenever it is available, it must be done in cases of aluminium phosphide poisoning. Serum troponin-I test should be done to assess significant myocardial damage. Thus, proper clinical work out along with relevant investigations and management as per standard protocol may save many more lives.

Study of Toxic Effect of Aluminium Phosphide Poisoning on Myocardium in Thirty Patients Treated in Tertiary Care Hospital

Study of Toxic Effect of Aluminium Phosphide Poisoning on Myocardium in Thirty Patients Treated in Tertiary Care Hospital

Frequency of Cardiac Arrhythmias in Patients with Aluminum Phosphide Poisoning

Background: Cardiac failure is the major lethal consequence of aluminum phosphide (AlP) poisoning. This study was designed to determine the frequency of cardiac arrhythmias in patients with AlP poisoning. Methods: In this prospective cross-sectional study, patients with definitive history of AlP poisoning treated at emergency department of Allied Hospital Faisalabad, Faisalabad, Pakistan, from July 2013 to November 2014 were included. On admission, twelve-lead electrocardiogram (ECG) was performed for all patients. During admission, all patients underwent continuous cardiac monitoring using a cardiac monitor. If an arrhythmia was suspected on the cardiac monitor, another ECG was obtained immediately. Results: During the study period, 100 patients with AlP poisoning (63% men) were treated at Allied Hospital Faisalabad. Mean age of the patients was 26.7 ± 7.9 years ranging from 16 to 54 years. Tachycardia was detected in 68 patients and bradycardia in 12 patients. Hypotension was observed in 75 patients. Eighty patients developed cardiac arrhythmia. The most frequent arrhythmia was atrial fibrillation (31% of patients) followed by ventricular fibrillation (20%), ventricular tachycardia (17%), 3rd degree AV block (7%) and 2nd degree AV block (5%). In total, 78 patients died, depicting a 78% mortality rate following wheat pill poisoning. Among those who died, seventy-one patients had cardiac arrhythmia. Comparison of death rate between patients with and without cardiac arrhythmia showed a significant difference (71/80 (88.8%) vs. 7/20 (35%); P < 0.001). Conclusion: Wheat pill poisoning causes a very high mortality, and circulatory collapse is the major cause of death among these patients. Most of the patients with AlP poisoning develop cardiac arrhythmias which are invariably life threatening. Early detection of cardiac disorders and proper management of arrhythmias may reduce mortalities.

Aluminum Phosphide Poisoning-Related Deaths in Tehran, Iran, 2006 to 2013.

Metal phosphides such as aluminum phosphide are potent insecticides. This highly toxic substance is used for rice and other grains protection in Iran. Due to its high toxicity potential and easy availability, it is widely used as a suicide poison. This substance has no effective antidote and the incidence of deaths due to its poisoning is increasing day by day in Iran.The present study was conducted to show the increasing incidence of fatal aluminum phosphide poisoning and its toxicological and forensic aspects in an 8-year study, 2006 to 2013. Autopsy sheets were reviewed and cases with the history of aluminum phosphide poisoning were selected. Toxicological analysis results, demographic and necroscopic examination findings were studied. A total of 51.8% of studied cases were female. Most of the cases were between 10 and 40 years old. The manner of death was self-poisoning in 85% of cases. Morphine, ethanol, and amitriptyline were the most common additional drugs detected in toxicological analysis. The incidence of fatal aluminum phosphide poisoning cases referred for phosphine analysis was 5.22 and 37.02 per million of population of Tehran in 2006 and 2013, respectively. The results of this study showed that in spite of ban and restrictions, there was a dramatic increase in the incidence of fatal aluminum phosphide poisoning in Tehran from 2006 to 2013. Safety alert should be highlighted in training program for all population groups about the toxic effects of aluminum phosphide tablets.

Aluminium phosphide induced acute kidney injury

Aluminium phosphide is one of the most common agricultural poisons being consumed in north India. Consumption of a fresh tablet is lethal as no antidote is available. Acute intoxication primarily presents with cardiovascular collapse due to myocardial toxicity. We report here a case of acute severe poisoning along with cardiovascular collapse and oliguria. The patient developed acute kidney injury during the illness (a rare entity in aluminium phosphide poisoning), which completely resolved following prompt conservative treatment.

Extra corporeal life support, a savior in aluminum phosphide poisoning

Toxic myocarditis is a less explored indication of extracorporeal life support (ECLS) in our country. We present a case of use of ECLS in severe left ventricular dysfunction induced by aluminum phosphide (ALP) poisoning. As refractory arrhythmias and myocardial failure have been established as the primary cause of death in ALP poisoning, ECLS can prove to be a useful adjunct to the supportive management.

Molecular and biochemical evidences on the protective effects of triiodothyronine against phosphine-induced cardiac and mitochondrial toxicity.

Aluminum phosphide (AlP) is a widely used fumigant and rodenticide. While AlP ingestion leads to high mortality, its exact mechanism of action is unclear. There are ample evidences suggesting cardioprotective effects of triiodothyronine (T3). In this study, we aimed to examine the potential of T3 in the protection of a rat model of AlP induced cardiotoxicity. In order to induce AlP intoxication animals were intoxicated with AlP (12 mg/kg; LD50) by gavage. In treatment groups, T3 (1, 2 and 3 μg/kg) was administered intra-peritoneally 30 min after AlP administration. Animals were connected to the electronic cardiovascular monitoring device simultaneously after T3 administration. Then, electrocardiogram (ECG), blood pressure (BP), and heart rate (HR) were monitored for 180 min. Additionally, 24h after AlP intoxication, rats were deceased and the hearts were dissected out for evaluation of oxidative stress, cardiac mitochondrial function (complexes I, II and IV), ATP/ADP ratio, caspases 3 & 9, and apoptosis by flow cytometry. The results demonstrated that AlP intoxication causes cardiac toxicity presenting with changes in ECG patterns such as decrement of HR, BP and abnormal QRS complexes, QTc and ST height. T3 at a dose of 3 μg/kg significantly improved ECG and also oxidative stress parameters. Furthermore, T3 administration could increase mitochondrial function and ATP levels within the cardiac cells. In addition, administration of T3 showed a reduction in apoptosis through diminishing the caspase activities and improving cell viability. Overall, the present data demonstrate the beneficial effects of T3 in cardiotoxicity of AlP.

The Role of Levosimendan in Acute Aluminum Phosphide Induced Myocardial Toxicity

Acute aluminum phosphide poisoning (AAlPP) or celphos is one of the most commonly used poisons for suicidal purpose. Number of cases reported to the hospital represents only the tip of an iceberg. Most of the patients succumb to this poison due to inadequate or lack of treatment. In our case, we added levosimendan to the already established treatment guidelines for AAlPP poisoning and we got surprising result as we could discharge the patient from our Intensive Care Unit in just 2 days with all vitals stable.

Predictors of Prognosis in Acute Aluminum Phosphide Poisoning

Aluminum phosphide (AP) is a highly toxic pesticide that is commonly used for grain preservation. Acute AP poisoning is a serious public health problem and a real challenge for physicians in developing countries because of the high rates of morbidity and mortality. This study was conducted to identify predictors that might be useful in determination of prognosis for cases of acute AP intoxication. All cases of aluminum phosphide poisoning that had been referred to Tanta University Poison Control Center from March 2013 to February 2015 were included. Patients were subjected to full history taking including demographic features, and their clinical examination data were reported. Electrocardiography, serum cardiac troponin, arterial blood gases, complete blood count were recorded, and their associations with the patients’ outcomes were evaluated. Forty cases (11 males and 29 females) of acute AP poisoning were included in this study. Mortality rate was 67.5%. A statistically significant association was found between each of abnormal electrocardiography findings, elevated serum troponin level, low blood pH, serum bicarbonate, and serum glucose with the risk of mortality. Other alarming risk factors included suicidal ingestion, altered consciousness, hypokalemia, and leukocytosis. It could be concluded that, patients presenting with one or more of these findings are at higher risk of mortality. Early anticipation of these risks by the attending physician may help proper early intervention and might minimize mortality and improve outcome in these cases.

Electrophysiological and molecular mechanisms of protection by iron sucrose against phosphine-induced cardiotoxicity: a time course study

The present study was designed for determining the exact mechanism of cytotoxic action of aluminum phosphide (AlP) in the presence of iron sucrose as the proposed antidote. Rats received AlP (12 mg/kg) and iron sucrose (5–30 mg/kg) in various sets and were connected to cardiovascular monitoring device. After identification of optimum doses of AlP and iron sucrose, rats taken in 18 groups received AlP (6 mg/kg) and iron sucrose (10 mg/kg), treated at six different time points, and then their hearts were surgically removed and used for evaluating a series of mitochondrial parameters, including cell lipid peroxidation, antioxidant power, mitochondrial complex activity, ADP/ATP ratio and process of apoptosis. ECG changes of AlP poisoning, including QRS, QT, P-R, ST, BP and HR were ameliorated by iron sucrose (10 mg/kg) treatment. AlP initiated its toxicity in the heart mitochondria through reducing mitochondrial complexes (II, IV and V), which was followed by increasing lipid peroxidation and the ADP/ATP ratio and declining mitochondrial membrane integrity that ultimately resulted in cell death. AlP in acute exposure (6 mg/kg) resulted in an increase in hydroxyl radicals and lipid peroxidation in a time-dependent fashion, suggesting an interaction of delivering electrons of phosphine with mitochondrial respiratory chain and oxidative stress. Iron sucrose, as an electron receiver, can compete with mitochondrial respiratory chain complexes and divert electrons to another pathway. The present findings supported the idea that iron sucrose could normalize the activity of mitochondrial electron transfer chain and cellular ATP level as vital factors for cell escaping from AlP poisoning.

Aluminium phosphide poisoning cases in a tertiary care hospital

Background: Aluminium phosphide is used to control rodents and pests in grain storage facilities. It produces phosphine gas, which is a mitochondrial poison. Unfortunately, there is no known antidote for aluminium phosphide intoxication and the mortality rate is very high. This type of poisoning (known as Kerry or Rice tablet poisoning) is common in Comilla region in Bangladesh. Methods: The study was an observational study and was conducted in the Department of Medicine and in Emergency Room of Comilla Medical College Hospital, Comilla, between February and August, 2013. Twenty five cases of Kerry tab. Poisoning were studied about their causes, clinical features, treatment and outcome. Results: Most of the patients (92%) were female and age range was 15-45 yrs. Familial disharmony was the main reason of their suicidal attempts. This poisoning was common in Chandina, Sadar, Debidar, Burichong, B.para, Muradnagar and Daudkandi upazillas of Comilla District. Vomiting and features of shock were the major clinical menifestations. Routine ECG was not done to these patients. Most of the patients (80%) were referred to higher centres in Dhaka after the primary management. Only 20% patients were survived due to early stomach wash and supporting medical management. One patient who survived also mentioned of taking date expired Kerry tablet. Conclusion: Strict implementation of nationwide pesticide regulation, including restricting the availability of poison, being aware of its toxicity and providing improved medical management and improved intensive care facilities can further reduce the mortality due to AlP toxicity as there is no antidote available presently. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22685 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 3-6