Fresh-Packed RBC Infusion Diminishes Acute AlP Poisoned-Patients' Mortality Rate: A Clinical Trial
-
Nastaran Rahimi
,
Behnam Behnoush
,
Hamed Hosseini
,
Amir A Fakhrabadi
,
Nina Javadian
,
Nasrin Barzegari arzegari Dahaj
,
Adeleh Maleki
,
Seyed Morteza Tabatabaei
,
Ahmad Reza Dehpour
Abstract
Accidental or intentional poisoning with Aluminum phosphide (AlP) is associated with severe complications such as metabolic acidosis, cardiac failure, and death. Previous animal experiments demonstrated that fresh-packed RBC is protective in an experimental model of AlP poisoning. The aim of this study was to assess the effect of fresh-packed RBC on survival in patients admitted to a referral hospital due to AlP poisoning in a randomized clinical trial. Eighty-two patients were admitted to Clinical Toxicology Unit at Baharloo Hospital due to acute AlP poisoning after approval by the Iranian Registry of Clinical Trials (registration reference: IRCT20180428039443N1). All patients received standard treatment, and forty-one of them received fresh-packed RBC. There was no significant difference between groups in the underlying characteristics, including vital signs and laboratory investigations. But interestingly, the mortality rate was meaningfully decreased (difference: 31.7%, 95% CI: 0.10-0.52) in patients receiving fresh-packed RBC (10 deaths/31 survived; 24.4% mortality) in comparison to standard treatment patients (23 deaths/18 survived; 56.1% mortality). Furthermore, fresh-packed RBC substantially improved the GCS, systolic/diastolic blood pressure, ST changes, and pH 12- and- 24 hours after admission. This study showed that fresh-packed RBC infusion alongside standard supportive treatment leads to a decrease in mortality rate; also, it provided evidence for a protective role of fresh-packed RBC in the management of patients with acute AlP poisoning.
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2. Ryan RF, De Lima C. Phosphine-an overview of a unique 80 year fumigant. General and Applied Entomology: The Journal of the Entomological Society of New South Wales. 2014;42:31.
3. Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology. 2012;63(1):61-73.
4. Dadpour B, Milani N, Mehrpour O, Najari F. Acute myocardial injury and electrocardiogram changes in a case of aluminum phosphide poisoning. International journal of medical toxicology and forensic medicine. 2019;9(2):91-6.
5. Perkins MW, Wong B, Tressler J, Rodriguez A, Sherman K, Andres J, et al. Adverse respiratory effects in rats following inhalation exposure to ammonia: respiratory dynamics and histopathology. Inhalation toxicology. 2017;29(1):32-41.
6. Nath NS, Bhattacharya I, Tuck AG, Schlipalius DI, Ebert PR. Mechanisms of phosphine toxicity. Journal of toxicology. 2011;2011.
7. Sciuto AM, Wong BJ, Martens ME, Hoard-Fruchey H, Perkins MW. Phosphine toxicity: a story of disrupted mitochondrial metabolism. Annals of the New York Academy of Sciences. 2016;1374(1):41.
8. Pannu A, Bhalla A, Gantala J, Sharma N, Kumar S, Dhibar D. Glucose-insulin-potassium infusion for the treatment of acute aluminum phosphide poisoning: an open-label pilot study. Clinical Toxicology. 2020:1-6.
9. Elabbassi W, Chowdhury MA, Fachtartz AAN. Severe reversible myocardial injury associated with aluminium phosphide toxicity: a case report and review of literature. Journal of the saudi heart association. 2014;26(4):216-21.
10. Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: a review of literature. Forensic science international. 2012;214(1-3):1-6.
11. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clinical toxicology. 2009;47(2):89-100.
12. Chugh S, Jaggal K, Sharma A, Arora B, Malhotra K. Magnesium levels in acute cardiotoxicity due to aluminium phosphide poisoning. The Indian journal of medical research. 1991;94:437.
13. Moghadamnia AA. An update on toxicology of aluminum phosphide. DARU journal of Pharmaceutical Sciences. 2012;20(1):25.
14. Agrawal VK, Bansal A, Singh RK, Kumawat BL, Mahajan P. Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015;19(2):109.
15. Shadnia S, Rahimi M, Pajoumand A, Rasouli M-H, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Human & experimental toxicology. 2005;24(4):215-8.
16. Zamani N, Hassanian-Moghaddam H, Ebrahimi S. Whole blood exchange transfusion as a promising treatment of aluminium phosphide poisoning. Arhiv za higijenu rada i toksikologiju. 2018;69(3):275-7.
17. Baruah U, Sahni A, Sachdeva HC. Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: Report of two cases. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015;19(12):735.
18. Rahimi N, Abdolghaffari AH, Partoazar A, Javadian N, Dehpour T, Mani AR, et al. Fresh red blood cells transfusion protects against aluminum phosphide-induced metabolic acidosis and mortality in rats. PloS one. 2018;13(3):e0193991.
19. Zambelli AB, Leisewitz AL. A prospective, randomized comparison of Oxyglobin (HB‐200) and packed red blood cell transfusion for canine babesiosis. Journal of Veterinary Emergency and Critical Care. 2009;19(1):102-12.
20. Swietach P, Tiffert T, Mauritz JM, Seear R, Esposito A, Kaminski CF, et al. Hydrogen ion dynamics in human red blood cells. The Journal of physiology. 2010;588(24):4995-5014.
21. Borawski J, Myśliwiec M. Hemoglobin level is an important determinant of acid-base status in hemodialysis patients. Nephron. 2002;90(1):111-3.
22. Mehrpour O, Asadi S, Yaghoubi MA, Azdaki N, Mahmoodabadi N, Javadmoosavi S. Cardiogenic shock due to aluminum phosphide poisoning treated with intra-aortic balloon pump: a report of two cases. Cardiovascular toxicology. 2019;19(5):474-81.
23. Mohammadi AB, Nahandi MZ. An Epidemiological Study of Aluminum Phosphide Poisoning in Patients Admitted in a Specialized Poisoning Referral Center in Northern Iran. Depiction of Health. 2019;2(3):7-12.
24. Singh S, Singh D, Wig N, Jit I, Sharma B-K. Aluminum phosphide ingestion—a clinico-pathologic study. Journal of Toxicology: Clinical Toxicology. 1996;34(6):703-6.
25. Kordrostami R, Akhgari M, Ameri M, Ghadipasha M, Aghakhani K. Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015. DARU Journal of Pharmaceutical Sciences. 2017;25(1):15.
26. Khosla S, Nand N, Kumar P. Cardiovascular complications of aluminum phosphide poisoning. Angiology. 1988;39(4):355-9.
27. Akkaoui M, Achour S, Abidi K, Himdi B, Madani A, Zeggwagh AA, et al. Reversible myocardial injury associated with aluminum phosphide poisoning. Clinical toxicology. 2007;45(6):728-31.
28. Maleki A, Hosseini MJ, Rahimi N, Abdollahi A, Akbarfakhrabadi A, Javadian N, et al. Adjuvant potential of selegiline in treating acute toxicity of aluminium phosphide in rats. Basic & clinical pharmacology & toxicology. 2019;125(1):62-74.
29. Siddaiah LM, Adhyapak SM, Jaydev SM, Shetty GG, Varghese K, Patil CB, et al. Intra-aortic balloon pump in toxic myocarditis due to aluminum phosphide poisoning. Journal of medical toxicology. 2009;5(2):80-3.
30. Dreifus L, Pick A. A clinical correlative study of the electrocardiogram in electrolyte imbalance. Circulation. 1956;14(5):815-25.
31. Soltaninejad K, Beyranvand M-R, Momenzadeh S-A, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. Journal of forensic and legal medicine. 2012;19(5):291-3.
2. Ryan RF, De Lima C. Phosphine-an overview of a unique 80 year fumigant. General and Applied Entomology: The Journal of the Entomological Society of New South Wales. 2014;42:31.
3. Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology. 2012;63(1):61-73.
4. Dadpour B, Milani N, Mehrpour O, Najari F. Acute myocardial injury and electrocardiogram changes in a case of aluminum phosphide poisoning. International journal of medical toxicology and forensic medicine. 2019;9(2):91-6.
5. Perkins MW, Wong B, Tressler J, Rodriguez A, Sherman K, Andres J, et al. Adverse respiratory effects in rats following inhalation exposure to ammonia: respiratory dynamics and histopathology. Inhalation toxicology. 2017;29(1):32-41.
6. Nath NS, Bhattacharya I, Tuck AG, Schlipalius DI, Ebert PR. Mechanisms of phosphine toxicity. Journal of toxicology. 2011;2011.
7. Sciuto AM, Wong BJ, Martens ME, Hoard-Fruchey H, Perkins MW. Phosphine toxicity: a story of disrupted mitochondrial metabolism. Annals of the New York Academy of Sciences. 2016;1374(1):41.
8. Pannu A, Bhalla A, Gantala J, Sharma N, Kumar S, Dhibar D. Glucose-insulin-potassium infusion for the treatment of acute aluminum phosphide poisoning: an open-label pilot study. Clinical Toxicology. 2020:1-6.
9. Elabbassi W, Chowdhury MA, Fachtartz AAN. Severe reversible myocardial injury associated with aluminium phosphide toxicity: a case report and review of literature. Journal of the saudi heart association. 2014;26(4):216-21.
10. Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: a review of literature. Forensic science international. 2012;214(1-3):1-6.
11. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clinical toxicology. 2009;47(2):89-100.
12. Chugh S, Jaggal K, Sharma A, Arora B, Malhotra K. Magnesium levels in acute cardiotoxicity due to aluminium phosphide poisoning. The Indian journal of medical research. 1991;94:437.
13. Moghadamnia AA. An update on toxicology of aluminum phosphide. DARU journal of Pharmaceutical Sciences. 2012;20(1):25.
14. Agrawal VK, Bansal A, Singh RK, Kumawat BL, Mahajan P. Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015;19(2):109.
15. Shadnia S, Rahimi M, Pajoumand A, Rasouli M-H, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Human & experimental toxicology. 2005;24(4):215-8.
16. Zamani N, Hassanian-Moghaddam H, Ebrahimi S. Whole blood exchange transfusion as a promising treatment of aluminium phosphide poisoning. Arhiv za higijenu rada i toksikologiju. 2018;69(3):275-7.
17. Baruah U, Sahni A, Sachdeva HC. Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: Report of two cases. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015;19(12):735.
18. Rahimi N, Abdolghaffari AH, Partoazar A, Javadian N, Dehpour T, Mani AR, et al. Fresh red blood cells transfusion protects against aluminum phosphide-induced metabolic acidosis and mortality in rats. PloS one. 2018;13(3):e0193991.
19. Zambelli AB, Leisewitz AL. A prospective, randomized comparison of Oxyglobin (HB‐200) and packed red blood cell transfusion for canine babesiosis. Journal of Veterinary Emergency and Critical Care. 2009;19(1):102-12.
20. Swietach P, Tiffert T, Mauritz JM, Seear R, Esposito A, Kaminski CF, et al. Hydrogen ion dynamics in human red blood cells. The Journal of physiology. 2010;588(24):4995-5014.
21. Borawski J, Myśliwiec M. Hemoglobin level is an important determinant of acid-base status in hemodialysis patients. Nephron. 2002;90(1):111-3.
22. Mehrpour O, Asadi S, Yaghoubi MA, Azdaki N, Mahmoodabadi N, Javadmoosavi S. Cardiogenic shock due to aluminum phosphide poisoning treated with intra-aortic balloon pump: a report of two cases. Cardiovascular toxicology. 2019;19(5):474-81.
23. Mohammadi AB, Nahandi MZ. An Epidemiological Study of Aluminum Phosphide Poisoning in Patients Admitted in a Specialized Poisoning Referral Center in Northern Iran. Depiction of Health. 2019;2(3):7-12.
24. Singh S, Singh D, Wig N, Jit I, Sharma B-K. Aluminum phosphide ingestion—a clinico-pathologic study. Journal of Toxicology: Clinical Toxicology. 1996;34(6):703-6.
25. Kordrostami R, Akhgari M, Ameri M, Ghadipasha M, Aghakhani K. Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015. DARU Journal of Pharmaceutical Sciences. 2017;25(1):15.
26. Khosla S, Nand N, Kumar P. Cardiovascular complications of aluminum phosphide poisoning. Angiology. 1988;39(4):355-9.
27. Akkaoui M, Achour S, Abidi K, Himdi B, Madani A, Zeggwagh AA, et al. Reversible myocardial injury associated with aluminum phosphide poisoning. Clinical toxicology. 2007;45(6):728-31.
28. Maleki A, Hosseini MJ, Rahimi N, Abdollahi A, Akbarfakhrabadi A, Javadian N, et al. Adjuvant potential of selegiline in treating acute toxicity of aluminium phosphide in rats. Basic & clinical pharmacology & toxicology. 2019;125(1):62-74.
29. Siddaiah LM, Adhyapak SM, Jaydev SM, Shetty GG, Varghese K, Patil CB, et al. Intra-aortic balloon pump in toxic myocarditis due to aluminum phosphide poisoning. Journal of medical toxicology. 2009;5(2):80-3.
30. Dreifus L, Pick A. A clinical correlative study of the electrocardiogram in electrolyte imbalance. Circulation. 1956;14(5):815-25.
31. Soltaninejad K, Beyranvand M-R, Momenzadeh S-A, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. Journal of forensic and legal medicine. 2012;19(5):291-3.
| Files | ||
| Issue | Vol 60 No 11 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v60i11.11652 | |
| Keywords | ||
| Fresh packed (Red blood cell (RBC)) Aluminum phosphide (AlP) Poisoning Mortality rate Clinical trial | ||
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How to Cite
1.
Rahimi N, Behnoush B, Hosseini H, Fakhrabadi AA, Javadian N, arzegari Dahaj NB, Maleki A, Tabatabaei SM, Dehpour AR. Fresh-Packed RBC Infusion Diminishes Acute AlP Poisoned-Patients’ Mortality Rate: A Clinical Trial. Acta Med Iran. 2023;60(11):680-687.
