Document Type : Original Article

Authors

1 Department of Pharmacology & Toxicology, Faculty of Pharmacy ,Pharmaceutical Sciences Branch, Islamic Azad University ,Tehran - Iran (IAUPS )

2 Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran

4 toxicological Research Center, Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences,Loghman Hakim Hospital, Tehran, Iran.

5 Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

6 Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: Aluminum Phosphide toxicity is a common deliberate toxicity, and due to no specific antidote available for its treatment, most toxicity leads to death. The present study aimed to evaluate the efficacy of Hyper Insulin Euglycemia protocol in combination with vitamin E and N-Acetyl Cysteine in patients with acute ALP poisoning treatment.
Methods: In this incidental prospective clinical trial, 76 individuals with toxicity were enrolled and assigned into two groups: One treatment group undergoing by glucose, insulin, and potassium() administration in combination with vitamin E and N-Acetyl Cysteine,  and one control group who were mainly managed by supportive treatments. Signs and symptoms at arrival and during hospitalization, complications, and outcomes were recorded and compared between these two groups to find any possible effect of, vitamin E, and protocol for toxicity treatment.
Results: This study investigated the mortality and safety of therapy in 76 poisoning patients with an average age of 28. The mortality rate in the group was 26% lower than in the control group (p-value: 0.058). Furthermore, this research detected a significant rise in systolic blood pressure during hospitalization in the treatment group. Regarding pH and bicarbonate levels, the group showed less metabolic acidosis. In contrast to the case group, the therapy group's bicarbonate levels significantly increased throughout hospitalization.
Conclusion: Using the, vitamin E, and protocol accompanied by Symptomatic and supportive treatments in acute ALP toxicity among the treatment group of this study resulted in a significant increase in systolic blood pressure,  longer hospitalization duration, and lower death rates.
 

Keywords

Main Subjects

1. Pannu AK, Bhalla A, Gantala J, Sharma N, Kumar S, Dhibar DP. Glucose-insulin-potassium infusion for the treatment of acute aluminum phosphide poisoning: an open-label pilot study. Clin toxicol (Phila) 2020; 58(10): 1004-9.
2. Taghaddosinejad F, Farzaneh E, Ghazanfari-Nasrabad M, Eizadi-Mood N, Hajihosseini M, Mehrpour O. The effect of 
N-acetyl cysteine (NAC) on aluminum phosphide poisoning inducing cardiovascular toxicity: a case-control study. 
SpringerPlus 2016; 5(1): 1948.
3. Dorooshi G, Zoofaghari S, Mood NE, Gheshlaghi F. A Newly Proposed Management Protocol for Acute Aluminum 
Phosphide Poisoning. J res pharm pract 2018; 7(3): 168-9.
4. El-Sarnagawy G. Predictive factors of mortality in acute aluminum phosphide poisoning: 5 years retrospective study in Tanta Poison Control Unit. Ain Shams Journal of Forensic Medicine and Clinical Toxicology 2017; 29(2): 70-9.
5. Hassanian-Moghaddam H, Zamani N. Therapeutic role of hyperinsulinemia/euglycemia in aluminum phosphide 
poisoning. Medicine (Baltimore). 2016 Aug;95(31):e4349.
6. Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S. Acute adult and adolescent 
poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011. Arch Iran Med. 2014 Aug;17(8):534-8.
7. Mégarbane B, Karyo S, Baud FJ. The role of insulin and glucose (hyperinsulinaemia/euglycaemia) therapy in acute 
calcium channel antagonist and β-blocker poisoning. Toxicol Rev. 2004;23(4):215-22.
8. Holger JS, Stellpflug SJ, Cole JB, Harris CR, Engebretsen KM. High-dose insulin: a consecutive case series in toxininduced cardiogenic shock. Clin Toxicol (Phila). 2011 Aug;49(7):653-8.
9. Fu J, Yu MG, Li Q, Park K, King GL. Insulin's actions on vascular tissues: Physiological effects and pathophysiological 
contributions to vascular complications of diabetes. Mol Metab. 2021 Oct;52:101236.
10. Clerk LH, Vincent MA, Lindner JR, Clark MG, Rattigan S, Barrett EJ. The vasodilatory actions of insulin on resistance 
and terminal arterioles and their impact on muscle glucose uptake. Diabetes Metab Res Rev. 2004 Jan-Feb;20(1):3-12.
11. De Backer D, Creteur J, Dubois M-J, Sakr Y, Vincent J-L. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 2004; 147(1): 91-9.
12. Holger JS, Engebretsen KM, Fritzlar SJ, Patten LC, Harris CR, Flottemesch TJ. Insulin versus vasopressin and epinephrine to treat β-blocker toxicity. Clin Toxicol (Phila). 2007 May;45(4):396-401.
13. Kalra G, Anand I, Jit I, Bushnurmath B, Wahi P. Aluminium phosphide poisoning: haemodynamic observations. Indian Heart J. 1991 May-Jun;43(3):175-8.
14. Rahbar TM, Ourangpour R, Zarkami T, Palizkar M, Mousavian RZS. Survey patients poisoned with aluminum 
phosphide (rice tablet). 2006; 14 (56):42-47.
15. Singh S, Singh D, Wig N, Jit I, Sharma B-K. Aluminum phosphide ingestion—a clinico-pathologic study. J Toxicol 
Clin Toxicol. 1996;34(6):703.
16. Mets Brooks C, Stewart N. The clinical management of drug overdose and poisoning. WB Saunders company, 
Philadelphia; 1998.
17. Khodabandeh F, Kahani A, Soleimani G. The study of fatal complications of “rice tablet “poisoning. Iran J Forensic Med 2014; 20(2): 27-36.
18. Mehrpour O, Shadnia S, Soltaninejad K, Yaghmaii A. Survey the change of electrolyte level and blood glucose in patients with acute aluminium Phosphine poisoning (rice tablet). Iran J REFERENCES Forensic Med 2009; 53: 49-53.