Research paper: Cardiovascular conditions in patients with aluminum phosphide poisoning

Abstract

Background: Aluminum Phosphide (AlP) is a well-known rodenticide and insecticide, used as a fumigant to control pests and rodents in grain-storage facilities. Its intoxication presents a medical emergency that requires early rigorous management. This study aimed to investigate cardiac function by Electrocardiogram (ECG) changes in patients with AlP intoxication. We also explored the potential relationship between low bicarbonate and cardiac function. Methods: This cross-sectional study investigated 42 patients in the age range of 17-47 years, with a history of orally-administered AlP poisoning, known as "rice tablet", admitted to the toxicology ward of Imam Reza Hospital from March 2019 to March 2021. The study patients' demographic data were collected by trained interviewers, using pretested questionnaires. Systolic and diastolic blood pressure, as well as blood samples, were measured 12 hours from admission. Echocardiography was performed during the first 12 hours and on the fifth-day post-admission. All statistical analysis was performed using R 3.6.1. The significance level was set at 0.05 for all statistical tests. Results: In total, 48.78% of patients presented normal bicarbonate levels, and 24.39% and 26.83% had moderate and severe acidity, respectively. Moderately and severely decreased Left Ventricular Ejection Fraction (LVEF) was observed among 21 (51.2%) and 10 (24.4%) patients, respectively. Furthermore, mild Right Ventricular (RV) function was observed among 11 (26.8%) patients. A statistically significant association was observed between bicarbonate level and RV function (P<0.001) and LVEF (P<0.001). Besides, 19.5% of the explored patients expired. The proportion of expired patients was significantly higher in patients with mild RV function, compared to the other patients (P<0.001). Conclusion: Acute AlP intoxication is a worldwide serious problem. Severe metabolic acidosis and ECG abnormalities are associated with poor outcomes in this respect. Thus, conducting early ECG and echocardiography could be desirable instruments to predict prognosis. There is no antidote for AlP poisoning; thus, the replacement of a safer agent for in-store grain protection is strongly suggested.