Potential role of paraffin oil gastric lavage in acute aluminum phosphide poisoning: a randomized controlled trial.
Aluminum phosphide
Clinical trial
Mechanical ventilation
Mortality
Paraffin oil
Prognosis
Journal
Environmental science and pollution research international
ISSN: 1614-7499
Titre abrégé: Environ Sci Pollut Res Int
Pays: Germany
ID NLM: 9441769
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
09
08
2021
accepted:
23
11
2021
pubmed:
16
1
2022
medline:
10
5
2022
entrez:
15
1
2022
Statut:
ppublish
Résumé
Aluminum phosphide (ALP) poisoning is a true medical emergency associated with high mortality. The lack of a specific antidote for ALP poisoning mandates searching for new treatment modalities. This study aimed to evaluate the effectiveness and safety of gastric decontamination by paraffin oil in cases with acute ALP poisoning. This study was a randomized, controlled, parallel-group, single-blind, phase II clinical trial conducted over a period of 6 months. Sixty-two patients with acute ALP poisoning were randomly allocated into two equivalent groups. In both groups, the standard ALP treatment was given. Gastric decontamination in the control group was performed by saline and sodium bicarbonate 8.4%, while in the intervention group, it was done by paraffin oil and sodium bicarbonate 8.4%. All patients were subjected to history taking, clinical examination, and laboratory investigations. The outcomes were evaluated. The median age of the studied patients was 20 years. Most of the studied cases were females, single, and from rural areas. The median delay time was 1 h. All patients included in the study alleged ingestion of ALP during suicidal attempts. Twelve hours after admission, many clinical and laboratory findings were significantly better in the intervention group. The need for intubation, mechanical ventilation, and total amount of vasopressors was significantly lower, and the mortality rate was non-significantly lower in the intervention group compared to the control. The median length of hospital stay was significantly shorter in the control group. Gastric decontamination with paraffin oil and sodium bicarbonate 8.4% could be valuable in reducing ALP poisoning severity, the need for intubation, mechanical ventilation, and vasopressors.
Identifiants
pubmed: 35031985
doi: 10.1007/s11356-021-17778-8
pii: 10.1007/s11356-021-17778-8
doi:
Substances chimiques
Aluminum Compounds
0
Oils
0
Pesticides
0
Phosphines
0
Paraffin
8002-74-2
paraffin oils
8012-95-1
Sodium Bicarbonate
8MDF5V39QO
aluminum phosphide
E23DR6L59S
Types de publication
Clinical Trial, Phase II
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
33844-33855Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Abd Elghany S, Heshmat M, Oreby M, Elsarnagawy G (2018) Evaluation of various scoring systems in prediction of acute aluminum phosphide (ALP) poisoning outcome. Ain-Shams J Forensic Med Clin Toxicol 30:117-127. https://doi.org/10.21608/ajfm.2018.18202
Abdel-Hady RH, Mohamed AA, Mohammed MK (2019) Supportive measures in the treatment of aluminum phosphide poisoning as a trial to reduce mortality at Assiut university hospital, Egypt. Arab Journal of Forensic Sciences & Forensic Medicine 1:1210-1222. https://doi.org/10.26735/16586794.2019.008
Agrawal VK, Bansal A, Singh RK, Kumawat BL, Mahajan P (2015) Aluminum phosphide poisoning: possible role of supportive measures in the absence of specific antidote. Indian J Crit Care Med 19:109–112. https://doi.org/10.4103/0972-5229.151019
doi: 10.4103/0972-5229.151019
Amiri, H, Vaseie, L, Habibollahi, P, Ghodrati, N (2016) Rice tablet: an overview to common material in Iran. J Anal Res Clin Med 4:77-81. https://doi.org/10.15171/jarcm.2016.013
Anand R, Sharma D, Verma D, Bhalla A, Gill K, Singh S (2013) Mitochondrial electron transport chain complexes, catalase and markers of oxidative stress in platelets of patients with severe aluminum phosphide poisoning. Hum Exp Toxicol 32:807–816. https://doi.org/10.1177/0960327112468909
doi: 10.1177/0960327112468909
Ataei, Z, Dadpour, B, Alizadeh, A, Mousavi, SR, Moshiri, M, Sheikhveisi, Z, Yazdipour, AB (2021) Cardiovascular conditions in patients with aluminum phosphide poisoning. Int J Med Toxicol Forensic Med 11:30188-30194. https://doi.org/10.32598/ijmtfm.v11i2.30188
Bogale DE, Ejigu BD, Muche TA (2021) Clinical profile and treatment outcome of aluminum phosphide poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: a retrospective study. Open Access Emerg Med. 13:239-248. https://doi.org/10.2147/OAEM.S313181
Chugh SN, Ram S, Chugh K, Malhotra KC (1989) Spot diagnosis of aluminium phosphide ingestion: an application of a simple test. J Assoc Physicians India 37:219–220
Clark, L, Fairhurst, C, Torgerson, DJ (2016) Allocation concealment in randomised controlled trials: are we getting better? Br Med J. 355: https://doi.org/10.1136/bmj.i5663
Darwish RT, Sobh ZK, Hamouda EH, Saleh EM (2020) The efficacy of coenzyme Q10 and liquid paraffin oil in the management of acute aluminum phosphide poisoning. Toxicol Res 9:444–453. https://doi.org/10.1093/toxres/tfaa045
doi: 10.1093/toxres/tfaa045
Dayananda, V, Satish Kumar, M, Rakesh Kumar, B (2018) Coconut oil as an adjuvant to magnesium sulphate therapy in acute aluminum phosphide consumption. Int J Anesth Res 6:509-514. https://doi.org/10.19070/2332-2780-18000102
Devi, KJ, Soreingam, K, Singh, VK (2016) Role of coconut oil and soda bicarbonate in gastric lavage in the management of celphos poisoning. J Health Res Rev 3:31-34. https://doi.org/10.4103/2394-2010.177495
Doig GS, Simpson F (2005) Randomization and allocation concealment: a practical guide for researchers. J Crit Care 20:187–191. https://doi.org/10.1016/j.jcrc.2005.04.005
doi: 10.1016/j.jcrc.2005.04.005
Dua R, Gill KD (2004) Effect of aluminium phosphide exposure on kinetic properties of cytochrome oxidase and mitochondrial energy metabolism in rat brain. Biochim Biophys Acta 1674:4–11. https://doi.org/10.1016/j.bbagen.2004.05.003
doi: 10.1016/j.bbagen.2004.05.003
Dua R, Sunkaria A, Kumar V, Gill KD (2010) Impaired mitochondrial energy metabolism and kinetic properties of cytochrome oxidase following acute aluminium phosphide exposure in rat liver. Food Chem Toxicol 48:53–60. https://doi.org/10.1016/j.fct.2009.09.014
doi: 10.1016/j.fct.2009.09.014
El Sawaf MMG, Abo Samak AM, Shahin MM, Hodeib AA (2019) Gastric decontamination in acute aluminium phosphide poisoning: saline –versus vegetable oils Randomized Controlled Trial. Tanta University
Elabdeen S, Saad K, Oreby M, Elgazzar F (2020) Assessment of intravenous lipid emulsion as an adjuvant therapy in acute aluminum phosphide poisoning: a randomized controlled trial. Ain-Shams J Forensic Med Clin Toxicol 34:51–68. https://doi.org/10.21608/ajfm.2020.68225
doi: 10.21608/ajfm.2020.68225
Elgazzar, FM, Keshk, W, Khalifa, H (2019) Early L-carnitine therapy in severe acute aluminum phosphide poisoning: a randomized controlled clinical trial. Egypt J Forensic Sci Appli Toxicol. 19:147-164. https://doi.org/10.21608/ejfsat.2020.17184.1097
Emam, N, Shaaban, S, Ahmed, D (2020) Could N. Acetyl cysteine prolong survival time in acute aluminum phosphide poisoning among Egyptian patients? Egyptian Society of Clinical Toxicology Journal 8:1-12. https://doi.org/10.21608/esctj.2020.40167.1000
Farahani, MV, Soroosh, D, Marashi, SM (2016) Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: an evidence-based review. Indian J Crit Care Med. 20:724-730. https://doi.org/10.4103/0972-5229.195712
Farahmand F, Eftekhari K, Modarresi V, Najafi-Sani M, Khodadad A, Motamed F (2010) Comparing oral route paraffin oil versus rectal route for disimpaction in children with chronic constipation; a randomized control trial. Iran J Pediatr 20:291–296
Ghonem, MM, El Sharkawy, SI, Lashin, HI (2020) Predictive variables of acute aluminum phosphide poisoning outcome: a new proposed model. Egypt J Forensic Sci Appli Toxicol. 20:45-60. https://doi.org/10.21608/ejfsat.2020.18651.1106
Goswami M, Bindal M, Sen P, Gupta SK, Avasthi R, Ram BK (1994) Fat and oil inhibit phosphine release from aluminium phosphide--its clinical implication. Indian J Exp Biol 32:647–649
Hashemi-Domeneh B, Zamani N, Hassanian-Moghaddam H, Rahimi M, Shadnia S, Erfantalab P, Ostadi A (2016) A review of aluminium phosphide poisoning and a flowchart to treat it. Arh Hig Rada Toksikol 67:183–193. https://doi.org/10.1515/aiht-2016-67-2784
doi: 10.1515/aiht-2016-67-2784
Hassanian-Moghaddam, H, Zamani, N (2016) Therapeutic role of hyperinsulinemia/euglycemia in aluminum phosphide poisoning. Medicine 95:e4349. https://doi.org/10.1097/MD.0000000000004349
Jaiswal, S, Verma, R, Tewari, N (2009) Aluminum phosphide poisoning: effect of correction of severe metabolic acidosis on patient outcome. Indian J Crit Care Med. 13:21-24. https://doi.org/10.4103/0972-5229.53111
Karimani A, Mohammadpour AH, Zirak MR, Rezaee R, Megarbane B, Tsatsakis A, Karimi G (2018) Antidotes for aluminum phosphide poisoning–an update. Toxicol Rep 5:1053–1059. https://doi.org/10.1016/j.toxrep.2018.10.009
doi: 10.1016/j.toxrep.2018.10.009
Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh A (2009) Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci 63:227–234
doi: 10.4103/0019-5359.53386
Mehrpour O, Amouzeshi A, Dadpour B, Oghabian Z, Zamani N, Amini S, Hoffman RS (2014) Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Arh Hig Rada Toksikol 65:121–127. https://doi.org/10.2478/10004-1254-65-2014-2393
doi: 10.2478/10004-1254-65-2014-2393
Moghadamnia AA (2012) An update on toxicology of aluminum phosphide. DARU J Pharm Sci 20:1–8. https://doi.org/10.1186/2008-2231-20-25
doi: 10.1186/2008-2231-20-25
Pajoumand A, Jalali N, Abdollah M, Shadnia S (2002) Survival following severe aluminium phosphide poisoning. J Pharm Pract Res 32:297–299. https://doi.org/10.1002/jppr2002324297
doi: 10.1002/jppr2002324297
Persson HE, Sjöberg GK, Haines JA, De Garbino JP (1998) Poisoning severity score. Grading of acute poisoning. Clin Toxicol 36:205–213. https://doi.org/10.3109/15563659809028940
doi: 10.3109/15563659809028940
Shadnia, S, Rahimi, M, Pajoumand, A, Rasouli, M-H, Abdollahi, M (2005) Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Hum Exp Toxicol 24:215-218. https://doi.org/10.1191/0960327105ht513oa
Sharif F, Crushell E, O'driscoll K, Bourke B (2001) Liquid paraffin: a reappraisal of its role in the treatment of constipation. Arch Dis Child 85:121–124. https://doi.org/10.1136/adc.85.2.121
doi: 10.1136/adc.85.2.121
Singh S, Bhalla A, Verma SK, Kaur A, Gill K (2006) Cytochrome-c oxidase inhibition in 26 aluminum phosphide poisoned patients. Clin Toxicol 44:155–158. https://doi.org/10.1080/15563650500514467
doi: 10.1080/15563650500514467
Singh Y, Joshi SC, Satyawali V, Gupta A (2014) Acute aluminium phosphide poisoning, what is new? Egypt J Intern Med 26:99–103. https://doi.org/10.4103/1110-7782.145298
doi: 10.4103/1110-7782.145298
Torabi, Z, Amiraslani, S, Diaz, D, Ahmadiafshar, A, Eftekhari, K (2017) Comparison of paraffin versus polyethylene glycol (PEG) in children with chronic functional constipation. Int J Pediatr. 5:5843-5850. https://doi.org/10.22038/ijp.2017.23726.2004
Urganci N, Akyildiz B, Polat TB (2005) A comparative study: the efficacy of liquid paraffin and lactulose in management of chronic functional constipation. Pediatr Int 47:15–19. https://doi.org/10.1111/j.1442-200x.2004.02001.x
doi: 10.1111/j.1442-200x.2004.02001.x
Yadav D, Bhattacharyya R, Banerjee D (2021) Acute aluminum phosphide poisoning: the menace of phosphine exposure. Clin Chim Acta 520:34–42. https://doi.org/10.1016/j.cca.2021.05.026
doi: 10.1016/j.cca.2021.05.026
Yan H, Xiang P, Zhang S, Shen B, Shen M (2017) Diagnosis of aluminum phosphide poisoning using a new analytical approach: forensic application to a lethal intoxication. Int J Legal Med 131:1001–1007. https://doi.org/10.1007/s00414-017-1562-1
doi: 10.1007/s00414-017-1562-1