Fatalities Due to Poisoning with Aluminum Phosphide (Rice Pill) and Methadone

ABSTRACTAcute poisoning is commonly seen with pharmaceutical substance or pesticides. Understanding pattern of acute poisoning due to different agents can enable better emergency management. The aim of this study is to present and evaluate the fatality-related data of acute poisoning due to aluminum phosphide (rice pills) and methadone. This descriptive-analytical study was performed on patients Shahid Rahimi Hospital due to poisoning with rice tablets (aluminum phosphide) and methadone from 2015–2020. The data collection tool was a questionnaire using with demographic data, type and dose of poison and clinical presentation, duration of hospitalization was obtained and statistically analyzed. Out of 19 238 patients with poisoning referred to this center, 412 people referred to the hospital due to rice pill poisoning, of which 56 (13.59%) died and among 2157 patients due to methadone poisoning, 22 of them (1.09%) died. In both the groups, rice pill and methadone, there were more male patients 53.57 and 81.81%, respectively. In aluminum phosphide poisoning, the greatest population was in the age group (15–35). However, no specific age group was seen in methadone poisoning. The duration of hospitalization and the time of referral to the emergency department to the death of the patient was significantly correlated with mortality in both the groups. The prevalence of intentional rice kill poising was greatest, effecting young population, we recommend that health care awareness program and training should be provided in this regard. Furthermore, psychiatric care should be made easily available in the region.

Management of acute aluminum phosphide poisoning: Has anything changed?

: Due to its easy availability, rapid and severe toxicity, and no specific antidote, aluminum phosphide has emerged as a lethal toxin, commonly used for suicidal intent in agricultural communities. Despite various advances in medicine, this compound’s toxicity is poorly understood, and it still has a very high case fatality rate with no definitive treatment options available. This review aims to understand the mechanism of toxicity, clinical toxidrome of acute aluminum phosphide poisoning, and the available therapeutic options, including recent advances. A literature review was performed searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: (“aluminum phosphide poisoning” OR “aluminum phosphide poisoning toxicity” OR “aluminum phosphide ingestion”) AND (“management” OR “therapy” OR “treatment”). Selected articles were discussed amongst all the authors to shape this review. High case fatality rate and lack of any specific antidote are persisting challenges. Therapeutic measures need to be implemented from all fronts – reducing easy access to the poison, developing less toxic alternatives for use as a pesticide, and more studies directed at developing an effective reversal agent for phosphine. The advent of promising agents like glucose-insulin-potassium infusion and lipid emulsion is a new ray of hope in the complete recovery in this fatal poisoning. The current need of the hour is to find an agent that rapidly and effectively reverses aluminum phosphide's toxic effects. Large multicenter controlled trials are required to establish the role of glucose-insulin-potassium and lipid emulsion.

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.

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.