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. |
- Saeed A, Bashir Z, Khan D, Iqbal J, Raja KS, Rehman A. Epidemiology of suicide in Faisalabad. J Ayub Med Coll Abottabad 2002;14:34-7.
- Ranjbar R, Liaghat AR, Ranjbar A, Mohabbati H. Toxicologic Laboratory Findings in Cases Reported with Hanging Death: a Two-Year Retrospective Study in Northeast Iran. Asia Pac J Med Toxicol 2013;2:92-5.
- Mostafazadeh B, Farzaneh E. Risks and risk factors of repeated suicidal attempt: Study on unconscious poisoned patients. Asia Pac J Med Toxicol 2013;2:28-31.
- Abidi M, Zia W, Waqas M. Deliberate self harm: A local perspective. J Pak Psychiatry Soc 2010;7:67.
- Rathore R, Khan MZ. Morbidity, mortality and management of wheat pill poisoning. Esculapio J Services Inst Med Sci. Jan - Mar 2007;2(4):14-8.
- Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2012; 63:61-73.
- Nosrati A, Karami M, Esmaeilnia M. Aluminum phosphide poisoning: A case series in north Iran. Asia Pac J Med Toxicol 2013;2:111-3.
- Anand R, Sharma DR, Verma D, Bhalla A, Gill KD, Singh S. Mitochondrial electron transport chain complexes, catalase and markers of oxidative stress in platelets of patients with severe aluminum phosphide poisoning. Hum ExpToxicol 2013;32:807-16.
- Bhalla A, Mahi S, Sharma N, Singh S. Polyserositis: An unusual complication of aluminum phosphide poisoning. Asia Pac J Med Toxicol 2012;1:14-7.
- Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci 2009; 63:227-34.
- Proudfoot AT. Aluminium and zinc phosphide poisoning. ClinToxicol (Phila) 2009; 47:89-100.
- Dewan G. Analysis of Recent Situation of Pesticide Poisoning in Bangladesh: Is There a Proper Estimate? Asia Pac J Med Toxicol 2014;3:76-83.
- Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock 2011;4:378-84.
- Moghadamnia AA. An update on toxicology of aluminum phosphide. Daru 2012;20:25.
- Mehrpour O, Amouzeshi A, Dadpour B, Oghabian Z, Zamani N, Amini S, et al. Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Arh Hig Rada Toksikol 2014;65:121-6.
- Camm AJ, Bunce NH. Cardiovascular diseases In: Kumar P, Clark M. Kumar and Clark’s clinical medicine. 8th ed. Edinburgh, UK: Saunders; 2012: 669-790.
- Farooqi AN, Tariq S, Asad F, Abid F, Tariq O. Epidemiological profile of suicidal poisoning at Abbasi Shaheed Hospital. Annal Abbasi Shaheed Hosp Karachi Med Dent Coll 2004;9:502-5.
- Khurram M, Mahmood N. Deliberate self-poisoning: experience at a medical unit. J Pak Med Assoc 2008;58:455-6.
- Iftikhar R, Tariq KM, Saeed F, Khan MB, Babar NF. Wheat pill: clinical characteristics and outcome. Pak Armed Forces Med J 2011;61:350-3.
- Soltaninejad K, Beyranvand MR, Momenzadeh SA, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. J Forensic Leg Med 2012;19:291-3.
- Mehrpour O, Farzaneh E, Abdollahi M. Successful treatment of aluminum phosphide poisoning with digoxin: a case report and review of literature. Int J pharmacol 2011;7:761-4.
- Reyna-Medina M, Vázquez-de Anda GF, García-Monroy J, Valdespino-Salinas EA, Vicente-Cruz DC. Suicide attempt with aluminum phosphide poisoning. Rev Med Inst Mex Seguro Soc. 2013;51:212-7. (In Spanish)
- Hosseinian A, Pakravan N, Rafiei A, Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran. Indian J Med Sci 2011;65:143-50.
|
