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LETTER TO THE EDITOR
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 57

Effectiveness of plasmapheresis in aluminum phosphate poisoning


Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission06-Mar-2021
Date of Acceptance23-Mar-2021
Date of Web Publication06-May-2021

Correspondence Address:
Dr. Shafeajafar Zoofaghari
Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrpp.JRPP_21_27

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How to cite this article:
Shariat SS, Zoofaghari S, Gheshlaghi F. Effectiveness of plasmapheresis in aluminum phosphate poisoning. J Res Pharm Pract 2021;10:57

How to cite this URL:
Shariat SS, Zoofaghari S, Gheshlaghi F. Effectiveness of plasmapheresis in aluminum phosphate poisoning. J Res Pharm Pract [serial online] 2021 [cited 2021 Jun 19];10:57. Available from: https://www.jrpp.net/text.asp?2021/10/1/57/315523



Dear Editor,

Substances containing phosphide used as rodenticide are among the most fatal accidental and intentional poisonings associated with oxidative damages in all tissue cells. Patients develop severe hypotension and metabolic acidosis. There are no available data about specific antidotes for aluminum phosphide (ALP) compounds,[1] and ALP poisoning is a major cause of deaths in poisoning centers.[2]

The fatal dose of ALP for a 70 kg adult is 150–500 mg. In oral intake, the phosphine gas released is absorbed by the gastrointestinal tract with simple diffusion and is mainly excreted by the kidneys and lungs.

Phosphine, such as cyanide, inhibits mitochondrial cytochrome oxidase and cellular oxygen utilization. The direct toxic effects of phosphine on cardiac myocytes, fluid loss, and adrenal glands can induce profound circulatory collapse. Direct corrosive effects of phosphides and phosphine on the body tissues have been reported.[3],[4],[5]

Intentional and accidental intoxication with ALP remains a clinical problem, especially in the Middle East region.[3] Many medical interventions have been proposed to treat acute ALP poisoning patients, lacking supporting data for their clinical effectiveness.[4] Considering the increasing incidence of fatal ALP poisoning and its toxicological aspects, and the limitation of the current knowledge about ALP toxicity treatment, we propose plasmapheresis.[6]

In our University Hospital, which is a referral and regional poison management control center in Iran (Khorshid Medical Center affiliated with Isfahan University of Medical Sciences), we found that patients poisoned with ALP who underwent plasmapheresis in <6 h after ALP exposure had a better prognosis than the others and the rate of deaths is notably decreased. Based on this preliminary case series result, we have planned for a pilot interventional clinical trial to verify the hypothesis of the clinical use of plasmapheresis for acute ALP-poisoned patients. We hope to have the chance to publish the results in the next 2 years.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tawfik HM. Recent advances in management of aluminium phosphide poisoning. QJM Int J Med 2020;113 Suppl 1:hcaa049.002. [doi: https://doi.org/10.1093/qjmed/hcaa049.002].  Back to cited text no. 1
    
2.
Elgazzar FM. Assessment of Intravenous lipid emulsion as an adjuvant therapy in acute aluminum phosphide poisoning: A randomized controlled trial. QJM Int J Med 2020;113 Suppl 1:hcaa049.001. [doi: https://doi.org/100.1093/qjmed/hcaa049.001].  Back to cited text no. 2
    
3.
Gheshlaghi F, Lavasanijou MR, Moghaddam NA, Khazaei M, Behjati M, Farajzadegan Z, et al. N-acetylcysteine, ascorbic acid, and methylene blue for the treatment of aluminium phosphide poisoning: Still beneficial? Toxicol Int 2015;22:40-4.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Dorooshi G, Zoofaghari S, Mood NE, Gheshlaghi F. A newly proposed management protocol for acute aluminum phosphide poisoning. J Res Pharm Pract 2018;7:168-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Moghadamnia AA. An update on toxicology of aluminum phosphide. Daru 2012;20:25.  Back to cited text no. 5
    
6.
Tahergorabi Z, Zardast M, Naghizadeh A, Mansouri B, Nakhaei I, Zangouei M. Effect of aluminium phosphide (ALP) gas inhalation exposure on adipose tissue characteristics and histological toxicity in male rats. J Taibah Univ Sci. 2020;14:1317-25.  Back to cited text no. 6
    




 

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