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Abstract

ALUMINIUM PHOSPHIDE POISONING- A PROSPECTIVE CLINICO THERAPEUTIC STUDY IN TERTIARY CARE HOSPITAL OF EASTERN U.P. (GORAKHPUR)

Dr Rakesh Kumar*, Dr. Rajendra Choudhary, Dr. Mridul Bhushan, Dr. Rajesh Barnawa, Dr P.Nigam

ABSTRACT

Aluminium Phosphide (AlP) poisoning is extremely lethal poisoning. Ingestion is usually suicidal in intention Phosphine, which is liberated when AlP comes in contact with moisture, is injurious and effect the cellular respiration there by it became lethal. Absence of specific antidote results in high mortality. The key treatment lies on rapid decontamination and institution of resuscitative measures. The present study was under taken to study the salient features and ways to combat the deleterious effect of poisoning. Material And Methods: One hundred and twelve cases of proved AlP poisoning by AgNO3 Test constituted the clinical material. Each and every patient and /or relatives, friends were interrogated regarding amount of exposed or unexposed poison taken, when taken and the time when symptoms started appearing after ingestion of poison. They were submitted to relevant investigations to assess the severity of poisoning, hepato - renal and cardio respiratory status. At the same time they were managed as per guidelines laid by Bajpai SR.²¹. Observations and Results: The overall incidence of all type of poisoning was 0.29% i.e. 200 cases of poisoning out of total admission 67189 in medical wards during Oct. 2012 to March 2014. Amongst these 200 cases there was 112 cases (56%) of AlP poisoning. They were mainly from 3rd decade of life (mean age ± SD. = 22.45 ± 5.3 years) with male to female ratio of 2.7: 1. 73.2% From rural area and mostly were educated from High School to Graduate level (85 cases or 75.6%) Main causes were set-back in life, unemployment, home conflicts etc. Presenting symptoms reflect the irritation of the mucous membrane of GIT, presented with nausea, vomiting (100%) increased thirst (71.1%), pain in abdomen (42.8%) with altered bowel habits, respiratory distress (23.2%) altered consciousness , dizziness (33.9%) and Cardio Vascular abnormalities (53.5%) in the form of tachycardia profound shock i. e . systolic B.P. < 90 mmHg (75%) Icterus and oliguria was in 8.9% and 5.35% cases respectively. Laboratory findings reflect the severity and prognosis of poisoning.. Leucopenia (TLC . < 5000 /c mm ) in 4.4% cases, two to three fold increase in serum transaminases (22.3% ), hyper bilirubinemia (5.3%) and raised level of blood urea and serum creatinine in 32.1 of cases, hypomagnesemea was present in 16.18 % of cases. All of them were managed as soon as they reached the hospital with main aim to combat the shock, maintain the renal perfusion and to reduce the toxicity of AlP. Inspite of all these prompt and effective resusitatory measures the mortality was 42 .8 % which depends on the amount of exposed or unexposed AlP taken and duration of time when symtoms develop and how quickly the patient was treated. Conclusion: Good prognosis depends on the earliest the hospitalization with effective measures taken to combat the shock and promote the rapid excretion of poison through urine and gastro intestional tract.

Keywords: Aluminium Phosphide, Phosphine shocks, renal perfusion, renal and cardiac status.


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