Volume : IX, Issue : VIII, August - 2020

Prognostic markers in aluminum phosphide poisoning and role of bicarbonate and coconut oil in its management

Dr. Rambabu Singh, Dr. Prateek Saxena, Dr. Shweta Shrivastava, Dr. Vijay Kumar Gupta

Abstract :

INTRODUCTION– The organophosphate, organochlorines and aluminum phosphide (AlP) compounds are commonly used pesticides. Aluminium phosphide poisoning is increasing, particularly in rural region of northwest and central India largely due to lack of awareness and poor regulation regarding the accessibility of this gravely toxic compound.Mortality is very high (40–100%) among patients of aluminium phosphide poisoning, as there is no specific antidote available. There is limited Indian data available on prognostic markers & predictors of mortality. Hence, the purpose of the study is to study the prognostic markers in patients with ALP poisoning and to identify the role of bicarbonate & coconut oil (enteral and parentral) in its management AIMS/OBJECTIVES 1.To determine various prognostic factors in patients of Aluminium phosphide poisoning. 2. To study the role of bicarbonate (enteral and parentral) & coconut oil (enteral) in management of Aluminium phosphide poisoning. MATERIALS AND METHODS The study was conducted in the department of Medicine, MLB Medical College, Jhansi on 100 patients admitted to our hospital with history of ingestion of aluminium phosphide poisoning whether fresh or exposed tablets. Inclusion criteria was–1.Patients who have consumed aluminium phosphide,2.Patients/relatives who have given written informed consent,3.Patients of age >18yrs.Exclusion criteria was –1.Patients with unclear diagnosis of poisoning.2.Patients with consumption of more than one substance.3. Patients who have not given written informed consent. An initial resuscitation was done and Intravenous access was established and 1–2 litres of normal saline was administered within the first 1–2 hr guided by arterial mean blood pressure.Gastric lavage was initiated with aliquots of 50 mL of coconut oil and 50 mL of sodium bicarbonate solution and continued for the next half an hour, with simultaneous aspiration being done after every 3–5 min through Ryle‘s tube. Coconut oil was just heated to lukewarm temperature so as to make a miscible solution with sodium bicarbonate. The procedure of gastric lavage was usually done 10–15 times in the first hour .The arterial blood gas analysis of each patient was sent and the results were grouped according to the pH. Group A= patients with arterial ph less than 7.2 Group B= patients with arterial ph ≥ 7.2 Patient of group A were randomly subdivided into two groups– Group A1 =gastric lavage done with soda bicarbonate along with coconut oil and intravenous replacement with soda bicarbonate;Group A2=gastric lavage done with plain water/KMNO4 along with intravenous replacement with soda bicarbonate Patients of group B were randomly subdivided into two groups – Group B1= gastric lavage done with soda bicarbonate along with coconut oil ;Group B2= gastric lavage done with plain water/ KMNO4 RESULT– The following results were drawn from the study :– Maximum no. (77%) of patients were of younger age group (18–46 years) and it was more common in males (76%). Mortality rate was high in patients, who consumed more than two tablets (77.41%), fresh tablets(60.81%),time taken to reach hospital (>6hr)66.66% with glassgow coma scale (3–6) as well as APACHE II score>30(100%).Patients who needed inotropic support (77.19% mortality), mechanical ventilation(97.82% mortality) and presented with shock on admission (80%), pH value of <7.2(60.41%), serum bicarbonate levels <15 mmol/L (70.96%) and blood lactate levels >5 mmol/L(54.66%) were associated with poor prognosis. Electrocardiographic (ECG) abnormalities on admission (77.96%), raised troponin I levels (71.87%), serum creatinine level >2mg/dl (93.33%)were associated with fatal outcome. Peritoneal dialysis was beneficial in mortality outcome 40%(6/15). Gastric lavage done with coconut oil and sodium bicarbonate (A1+B1) and intravenous sodium bicarbonate when needed was superior to gastric lavage done with plain water/KMNO4(Group A2+B2) and intravenous sodium bicarbonate when needed in decreasing mortality in patients of aluminium phosphide poisoning patients (mortality rate (A1+B1) 32% vs (A2+B2) 60%; p= 0.004 as well as when ph<7.2 mortality was high in Group A (56%) compare to when ph≥7.2 in Group B(36%). CONCLUSION–In our study we concluded that early resuscitation and decontamination with the use of coconut oil and soda bicarbonate in gastric lavage, intensive monitoring and supportive therapy mortality was significantly decreased. We believe preventing high mortality by implementing peritoneal dialysis at early stages in severe patients although sample size was small so relationship should be further studied .Hence we recommend use of coconut oil along with soda bicarbonate lavage and peritoneal dialysis in cardiogenic shock patients for better results in aluminium phosphide poisoning.

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Article: Download PDF    DOI : 10.36106/ijsr  

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PROGNOSTIC MARKERS IN ALUMINUM PHOSPHIDE POISONING AND ROLE OF BICARBONATE AND COCONUT OIL IN ITS MANAGEMENT, Dr. Rambabu Singh, Dr. Prateek Saxena, Dr. Shweta Shrivastava, Dr. Vijay Kumar Gupta INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-9 | Issue-8 | August-2020

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