Prognostic significance of poison‑related factors and consumption patterns in acute aluminum phosphide poisoning
Lokhesh Chockalingam Anbalagan†, Ashok Kumar Pannu†, Ashish Bhalla, Deba Prasad Dhibar, Navneet Sharma
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Keywords: Aluminum phosphide, ingested dose, poison forms, poisoning, poison‑related factors, prognosis, reconstitution
OBJECTIVES: The prognosis of acute aluminum phosphide poisoning is usually based on toxidrome features, with little focus on poison related factors. We aimed to study the prognostic significance of poison related factors, consumption patterns, and time delays to treatment.
METHODS: We performed a prospective cohort study in an academic hospital in North India in patients aged ≥ 13 with aluminum phosphide poisoning from July 2019 to December 2020. During data collection, a particular emphasis was made on the poison formulation, the ingested dose, the reconstitution of poison, vomiting, and time intervals to initiate various treatments. The primary outcome was inhospital mortality.
RESULTS: Fifty eight patients were enrolled (median age, 32 years; 37 males). The mean dose of the ingested poison was 6.56 (±5.42) g. The predominant formulation of poison was pellet (n = 41), followed by powder (n = 16). Twenty patients performed reconstitution of poison before consumption, and 13 stirred the poison while reconstituting. All patients but three developed vomiting after consumption. Inhospital mortality (n = 23, 39%) was significantly high with a higher ingested dose (P < 0.001), nonstirred reconstitution before consumption (P = 0.042), fewer vomiting episodes (P = 0.010), a delay in detection of the victim by someone (P = 0.001), and delayed initiation of intravenous fluids (P = 0.043). The secondary outcomes (shock and requirement of vasopressor or ventilation) remained unaffected by the stirring in the reconstitution group.
CONCLUSIONS: Poison related factors and time intervals determine early risk stratification at admission in aluminum phosphide poisoning.
† These authors (Lokhesh Chockalingam Anbalagan and Ashok Kumar Pannu) contributed equally to the manuscript and are the joint first authors.
How to cite this article: Anbalagan LC, Pannu AK, Bhalla A, Dhibar DP, Sharma N. Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning. Turk J Emerg Med 2023;23:88-95.
The Institutional Ethics Committee of Postgraduate Institute of Medical Education and Research, Chandigarh (India) approved the study (No.: INT/IEC/2019/002071, date October 1, 2019).
Written informed consent was taken from all study patients or a legally authorized representative (if the patient could not consent). The study patients were explained about confidentiality and their information will be used for educational purposes only.
LAC: Data curation (lead), formal analysis (supporting), and writing – original draft (lead).
AKP: Conceptualization (supporting), methodology (supporting), formal analysis (lead), writing – original draft (supporting), writing – review, and editing (lead).
AB: Conceptualization (lead), methodology (lead), writing – review, and editing (supporting).
DPD: Conceptualization (supporting) and methodology (supporting).
NS: Conceptualization (supporting) and methodology (supporting).
The authors thank Mrs. Sunaina Verma for help in statistics.