Skip to main content

Advertisement

SpringerLink
Log in

The Role of Echocardiographic Findings in Estimating Survival Probability of Intensive Care Unit Admitted Aluminum Phosphide Poisoned Patients

  • Original Article
  • Published:
Journal of Medical Toxicology Aims and scope Submit manuscript

Abstract

Introduction

Cardiotoxicity represents the primary cause of death in acute aluminum phosphide (AlP) poisoning. Prompt supportive care can improve patient survival. This study assessed the role of echocardiography in estimating the survival probability of AlP-poisoned patients admitted to the intensive care unit.

Methods

A prospective cohort study of symptomatic acute AlP poisoned patients was conducted between September 2019 and December 2020. Patients were subjected to history taking, clinical examination, To be included, patient evaluation needed to include electrocardiographic (ECG) and echocardiographic studies. The statistical analysis assessed the association between patient survival and relevant factors. Survival analysis was performed using the Kaplan–Meier survival curve and Cox proportional hazard regression.

Results

A total of 90 patients met inclusion criteria. Electrocardiographic abnormalities were detected in 38.1% of survivors and 82.6% of non-survivors (p < 0.001). Survivors had a higher mean left ventricle ejection fraction (LVEF) (50.86 ± 6.30% vs. 26.52 ± 7.64%, respectively, p < 0.001) and a lower percentage of global LV hypokinesia (4.8% vs. 94.2%, p < 0.001). The mean survival time was higher among patients with LVEF ≥ 50% than those with LVEF = 41–49% and ≤ 40% (p = 0.014 and 0.001, respectively). The hazard of death was 4.42 and 5.40 times greater in patients with LVEF ≤ 40% or with global LV hypokinesia, respectively. Regression revealed that the global LV hypokinesia, ECG abnormalities, and decreased LVEF and oxygen saturation were significantly associated with the risk of death (hazard ratios: 4.382, 3.348, 0.957, and 0.971, respectively).

Conclusions

Echocardiography represents a valuable diagnostic tool to assess cardiac function in acute AlP poisoning. Both LVEF and global LV hypokinesia significantly impact the survival of AlP-poisoned patients. Echocardiography was superior to ECG changes in terms of accuracy for the prediction of mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Garg KK. Review of aluminum phosphide poisoning. IInt J Med Sci Public Health. 2020;9(7):392–400.

    Google Scholar 

  2. Badawi SM, Alseidy AM, Alfeki AK, Mansour M, Abd E-H. Metal phosphide poisoning in Menoufia University Hospitals. MMJ. 2018;31(3):816.

    Google Scholar 

  3. Farahani MV, Soroosh D, Marashi SM. Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: an evidence-based review. Indian J Crit Care Med. 2016;20(12):724–30. https://doi.org/10.4103/0972-5229.195712.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Hashemi-Domeneh B, Zamani N, Hassanian-Moghaddam H, Rahimi M, Shadnia S, Erfantalab P, Ostadi A. A review of aluminium phosphide poisoning and a flowchart to treat it. Arh Hig Rada Toksikol. 2016;67(3):183–93. https://doi.org/10.1515/aiht-2016-67-2784.

    Article  CAS  PubMed  Google Scholar 

  5. Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: a review of literature. Forensic Sci Int. 2012;214(1):1–6. https://doi.org/10.1016/j.forsciint.2011.06.018.

    Article  CAS  PubMed  Google Scholar 

  6. Halvaei Z, Tehrani H, Soltaninejad K, Abdollahi M, Shadnia S. Vitamin E as a novel therapy in the treatment of acute aluminum phosphide poisoning. Turk J Med Sci. 2017;47(3):795–800. https://doi.org/10.3906/sag-1512-6.

    Article  CAS  PubMed  Google Scholar 

  7. Asghari MH, Abdollahi M, de Oliveira MR, Nabavi SM. A review of the protective role of melatonin during phosphine-induced cardiotoxicity: focus on mitochondrial dysfunction, oxidative stress and apoptosis. J Pharm Pharmacol. 2017;69(3):236–43. https://doi.org/10.1111/jphp.12682.

    Article  CAS  PubMed  Google Scholar 

  8. Sciuto AM, Wong BJ, Martens ME, Hoard-Fruchey H, Perkins MW. Phosphine toxicity: a story of disrupted mitochondrial metabolism. Ann N Y Acad Sci. 2016;1374(1):41–51. https://doi.org/10.1111/nyas.13081.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Baruah U, Sahni A, Sachdeva HC. Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: report of two cases. Indian J Crit Care Med. 2015;19(12):735–8. https://doi.org/10.4103/0972-5229.171412.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Mehrpour O, Gurjar M. Cardiogenic shock: the main cause of mortality in acute aluminum phosphide poisoning. Indian J Crit Care Med. 2017;21(4):246–7. https://doi.org/10.4103/ijccm.IJCCM_97_17.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hassanian-Moghaddam H, Amiri H, Zamani N, Rahimi M, Shadnia S, Taherkhani M. QT dispersion and prognostication of the outcome in acute cardiotoxicities: a comparison with SAPS II and APACHE II scoring systems. Cardiovasc Toxicol. 2014;14(2):129–33. https://doi.org/10.1007/s12012-013-9236-9.

    Article  CAS  PubMed  Google Scholar 

  12. Kim YH, Lee JH, Hong CK, Cho KW, Park YH, Kim YW, Hwang SY. Heart rate-corrected QT interval predicts mortality in glyphosate-surfactant herbicide-poisoned patients. Am J Emerg Med. 2014;32(3):203–7. https://doi.org/10.1016/j.ajem.2013.09.025.

    Article  PubMed  Google Scholar 

  13. Lionte C, Sorodoc V, Bologa C, Tuchilus C, Jaba E. Usefulness of transthoracic echocardiography parameters and brain natriuretic peptide as mortality predictors in hospitalized acutely poisoned patients: a prospective observational study. Basic Clin Pharmacol Toxicol. 2017;120(5):498–504. https://doi.org/10.1111/bcpt.12711.

    Article  CAS  PubMed  Google Scholar 

  14. Soltaninejad K, Beyranvand MR, Momenzadeh SA, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. J Forensic Leg Med. 2012;19(5):291–3. https://doi.org/10.1016/j.jflm.2012.02.005.

    Article  PubMed  Google Scholar 

  15. Kalawat S, Thakur V, Thakur A, Punjabi N. Cardiovascular profile of aluminium phosphide poisoning and its clinical significance. Int Adv Med. 2016;3(4):859–64.

    Article  Google Scholar 

  16. Hilal MA, Mahmoud SE, Shokry MM, Said AM. Predictive role of cardiac troponin I, creatine kinase-Mb and electrocardiogram in early assessment of acute cardiotoxicity in patients poisoned by cardiotoxic drugs and toxins. Cardiol Angiol: Int J. 2020:18–30. https://doi.org/10.9734/ca/2020/v9i330136.

  17. Sheta AA, El-Banna AS, Elmeguid RA, Mohamed HE, Gad NH. A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score. Environ Sci Pollut Res Int. 2019;26(32):33135–45. https://doi.org/10.1007/s11356-019-06457-4.

    Article  CAS  PubMed  Google Scholar 

  18. Abdel-Hady RH, Mohamed AA, Mohammed MK. Supportive measures in the treatment of aluminum phosphide poisoning as a trial to reduce mortality at Assiut university hospital. Egypt AJFSFM. 2019;1:1210–22.

    Article  Google Scholar 

  19. Akkaoui M, Achour S, Abidi K, Himdi B, Madani A, Zeggwagh AA, Abouqal R. Reversible myocardial injury associated with aluminum phosphide poisoning. Clin Toxicol (Phila). 2007;45(6):728–31. https://doi.org/10.1080/15563650701517350.

    Article  CAS  Google Scholar 

  20. Oghabian Z, Mehrpour O. Treatment of aluminium phosphide poisoning with a combination of intravenous glucagon, digoxin and antioxidant agents. Sultan Qaboos Univ Med J. 2016;16(3):e352-e5; https://doi.org/10.18295/squmj.2016.16.03.015

  21. Changal KH, Latief M, Parry M, Abbas F. Aluminium phosphide poisoning with severe cardiac dysfunction and the role of digoxin. BMJ Case Rep. 2017;2017:bcr2017220125; https://doi.org/10.1136/bcr-2017-220125

  22. Elabbassi W, Chowdhury MA, Fachtartz AA. Severe reversible myocardial injury associated with aluminium phosphide toxicity: a case report and review of literature. J Saudi Heart Assoc. 2014;26(4):216–21. https://doi.org/10.1016/j.jsha.2013.11.006.

  23. 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. Cardiovasc Toxicol. 2019;19(5):474–81. https://doi.org/10.1007/s12012-019-09513-0.

    Article  PubMed  Google Scholar 

  24. Chugh SN, Ram S, Chugh K, Malhotra KC. Spot diagnosis of aluminium phosphide ingestion: an application of a simple test. J Assoc Physicians India. 1989;37(3):219–20.

    CAS  PubMed  Google Scholar 

  25. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, Group ESCSD. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42(36):3599–726; https://doi.org/10.1093/eurheartj/ehab368

  26. Moghadamnia AA, Abdollahi M. An epidemiological study of poisoning in northern Islamic Republic of Iran. East Mediterr Health J. 2002;8(1):88–94.

    Article  CAS  Google Scholar 

  27. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol (Phila). 2009;47(2):89–100. https://doi.org/10.1080/15563650802520675.

    Article  CAS  Google Scholar 

  28. Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci. 2009;63(6):227–34. https://doi.org/10.4103/0019-5359.53386.

    Article  CAS  PubMed  Google Scholar 

  29. El-Sarnagawy G. Predictive factors of mortality in acute aluminum phosphide poisoning: 5 years retrospective study in Tanta Poison Control Unit. Ain Shams J Forensic Med Clin Toxicol. 2017;29(2):70–9.

  30. Erfantalab P, Soltaninejad K, Shadnia S, Zamani N, Hassanian-Moghaddam H, Mahdavinejad A, Damaneh BH. Trend of blood lactate level in acute aluminum phosphide poisoning. World J Emerg Med. 2017;8(2):116–20. https://doi.org/10.5847/wjem.j.1920-8642.2017.02.006.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hosseini SF, Forouzesh M, Maleknia M, Valiyari S, Maniati M, Samimi A. The molecular mechanism of aluminum phosphide poisoning in cardiovascular disease: pathophysiology and diagnostic approach. Cardiovasc Toxicol. 2020;20(5):454–61. https://doi.org/10.1007/s12012-020-09592-4.

    Article  CAS  PubMed  Google Scholar 

  32. Solgi R, Baghaei A, Golaghaei A, Hasani S, Baeeri M, Navaei M, Ostad SN, Hosseini R, Abdollahi M. Electrophysiological and molecular mechanisms of protection by iron sucrose against phosphine-induced cardiotoxicity: a time course study. Toxicol Mech Methods. 2015;25(4):249–57; https://doi.org/10.3109/15376516.2015.1015086

  33. Chugh SN, Chugh K, Ram S, Malhotra KC. Electrocardiographic abnormalities in aluminium phosphide poisoning with special reference to its incidence, pathogenesis, mortality and histopathology. J Indian Med Assoc. 1991;89(2):32–5.

    CAS  PubMed  Google Scholar 

  34. Zniber K. Reversible myocardial injury associated with aluminum phosphide poisoning: case report. Sch J Med Case Rep. 2021;5:476–9.

  35. Shadnia S, Sasanian G, Allami P, Hosseini A, Ranjbar A, Amini-Shirazi N, Abdollahi M. A retrospective 7-years study of aluminum phosphide poisoning in Tehran: opportunities for prevention. Hum Exp Toxicol. 2009;28(4):209–13. https://doi.org/10.1177/0960327108097194.

    Article  CAS  PubMed  Google Scholar 

  36. 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 J Crit Care Med. 2015;19(2):109–12. https://doi.org/10.4103/0972-5229.151019.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. El Hangouche AJ, Fennich H, Alaika O, Dakka T, Raissouni Z, Oukerraj L, Doghmi N, Cherti M. Reversible myocardial injury and intraventricular thrombus associated with aluminium phosphide poisoning. Case Rep Cardiol. 2017;2017:6287015; https://doi.org/10.1155/2017/6287015

  38. Klaeboe LG, Edvardsen T. Echocardiographic assessment of left ventricular systolic function. J Echocardiogr. 2019;17(1):10–6. https://doi.org/10.1007/s12574-018-0405-5.

    Article  PubMed  Google Scholar 

  39. Park JS, Seo KW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Choi SC, Min YG, Shin JH. Various echocardiographic patterns of left ventricular systolic dysfunction induced by carbon monoxide intoxication. Cardiovasc Toxicol. 2016;16(4):361–9. https://doi.org/10.1007/s12012-015-9347-6.

    Article  CAS  PubMed  Google Scholar 

  40. Ozyurt A, Karpuz D, Yucel A, Tosun MD, Kibar AE, Hallioglu O. Effects of acute carbon monoxide poisoning on ECG and echocardiographic parameters in children. Cardiovasc Toxicol. 2017;17(3):326–34. https://doi.org/10.1007/s12012-016-9389-4.

    Article  CAS  PubMed  Google Scholar 

  41. Lionte C, Bologa C, Petris O, Sorodoc V, Stoica A, Tuchilus C, Jaba E, Coman AE, Vata L, Haliga R. Parameters influencing in-hospital mortality in acutely poisoned patients hospitalized in a medical or ICU ward: is there an influence of toxin-induced myocardial injury? Romanian Journal of Cardiology. 2019;29(3):404–10.

    Google Scholar 

  42. Bansal M, Ranjan S. Echocardiography in the management of cardiogenic shock. Indian J clinical Cardiology. 2020;1(1):20–30.

  43. Boyd JH, Sirounis D, Maizel J, Slama M. Echocardiography as a guide for fluid management. Crit Care. 2016;20(1):274. https://doi.org/10.1186/s13054-016-1407-1.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Mohammadi AB, Nahandi AZ, Solhi H. Utility of silver nitrate test for post-mortem diagnosis of aluminum phosphide poisoning. Iran J Toxicol. 2013;7(20):804–7.

Download references

Funding

None

Author information

Authors and Affiliations

  1. Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Medical Collages Complex, Tanta University, Al-Geesh Street, Tanta, 31527, Egypt

    Fatma M. Elgazzar & Amal S. A. F. Hafez

  2. Emergency Medicine and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Mohamed A. Shama

  3. Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Osama Shoeib

Authors
  1. Fatma M. Elgazzar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed A. Shama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osama Shoeib
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amal S. A. F. Hafez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FME and ASAFH conceived the study, contributed to the idea and the design of the research, and drafted the manuscript. FME also performed the statistical analysis of the data as well as edited and revised the manuscript in its final form. MAS shared the study design, collection of the data, AND interpretation of the results. OMS was responsible for performing and interpreting the echocardiography findings. All authors contributed substantially to the revision of the final manuscript.

Corresponding author

Correspondence to Fatma M. Elgazzar.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Supervising Editor: David Michael Wood, MD

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elgazzar, F.M., Shama, M.A., Shoeib, O. et al. The Role of Echocardiographic Findings in Estimating Survival Probability of Intensive Care Unit Admitted Aluminum Phosphide Poisoned Patients. J. Med. Toxicol. 18, 128–138 (2022). https://doi.org/10.1007/s13181-021-00868-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13181-021-00868-x

Keywords

Search

Navigation