Potential Therapeutic Role
Conditions
Brief summary
Aluminum phosphide (ALP) is a widely used fumigant due to its efficiency as pesticides. It is available as tablets of Celphos, Alphos or Quickphos which are known as rice tablets. Each tablet weights 3 grams and contains 56% ALP and 44% of aluminum carbonate and paraffin. The incidence of ALP poisoning increased steadily specially in developing countries . ALP poisoning is considered to be one of the major causes of suicidal poisoning owing to its wide accessibility and low cost. However, accidental poisoning may occur during occupational exposure
Detailed description
Aluminum phosphide (ALP) is a widely used fumigant due to its efficiency as pesticides. It is available as tablets of Celphos, Alphos or Quickphos which are known as rice tablets. Each tablet weights 3 grams and contains 56% ALP and 44% of aluminum carbonate and paraffin. The incidence of ALP poisoning increased steadily specially in developing countries . ALP poisoning is considered to be one of the major causes of suicidal poisoning owing to its wide accessibility and low cost. However, accidental poisoning may occur during occupational exposure. Signs and symptoms of acute AlP poisoning include gastrointestinal, cardiovascular, hepatic, renal, and neurologic (1). Ingestion of ALP causes mild gastrointestinal (GIT) manifestations as nausea, vomiting, abdominal pain, in addition to chest tightness, hypotension, headache and dizziness. In severe cases, GIT hemorrhage, shock, severe metabolic acidosis, cardiac arrhythmia, convulsions and coma may occur. Later, signs of hepatic damage and renal insufficiency may develop. Death usually occurs in 30-70% of cases within the first 24 hours resulting from refractory cardiogenic shock, cardiac arrhythmia, severe hypotension and metabolic acidosis.The main causes of cardiovascular collapse are increase capillary permeability, insufficient systemic vasoconstriction with low ventricular ejection fraction. On autopsy examinations, point to extravasation of fluid into the third space. The management is exclusively supportive as gastric lavage with KMnO4 solution, treatment of hypotension and acidosis in view of the fact that there is no specific antidote available.
Interventions
DRUGHydroxyethyl Starch 130-0.4 60 MG/ML [Voluven]
Hydroxyethyl starch dose is 500 cc in 6 hours
DRUGHydrocortisone
Hydrocortisone dose is 200-300 mg /day intravenously
DRUGPlacebo
received the standard ALP treatment according to TUPTC protocol as follows: patient resuscitation, care of airway, breathing and circulation, gastric decontamination with 2 ampoules sodium bicarbonate (each ampoule 25 ml containing 2.1 gm sodium bicarbonate) followed by activated charcoal in dose of 1 g/Kg orally, adequate hydration, normal saline administration (0.9% Sodium Chloride IV), vasopressors IV infusions, inhalation of 100% oxygen, ranitidine IV, magnesium sulfate IV infusion and other supportive treatment.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with severe acute aluminum phosphide poisoning * systolic blood pressure (SBP) ≤90 mmHg * PH ≤ 7.2 * HCO3 ≤15 meq/L * during the first six hours of admission
Exclusion criteria
* Pregnant and lactating women * Asymptomatic patients with history of acute aluminum phosphide exposure. * Patients with co-ingestion to other substances in addition to aluminum phosphide. * Patients with other major medical conditions (e.g. cardiovascular disease, renal or hepatic failure). * Patients with previous medical intervention (fluid therapy and vasopressors).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| mortality | 28 days from start of management | mortality rate of patients |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Need for mechanical ventilation | Through study completion up to 6 months | incidence of need for intubation and mechanical ventilation for each patient |
| need for ICU admission | Through study completion up to 6 months | the incidence of need for ICU admission for each patient |
Countries
Egypt
Outcome results
None listed