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Cardiogenic Shock Due to Aluminum Phosphide Poisoning Treated with Intra-aortic Balloon Pump: A Report of Two Cases

  • Omid MehrpourEmail author
  • Sadegh Asadi
  • Mohammad Ali Yaghoubi
  • Nahid Azdaki
  • Nastaran Mahmoodabadi
  • SeyedYoosef Javadmoosavi
Article
  • 17 Downloads

Abstract

The mortality rate from aluminum phosphide (AlP) poisoning is as high as 70–100%, with refractory hypotension and severe metabolic acidosis being the two most common presentations in this poisoning. As this poisoning has no specific antidote, treatments revolve around supportive care. Cardiogenic shock created by toxic myocarditis is considered the main cause of mortality in these patients. Meanwhile, the intra-aortic balloon pump (IABP) has been suggested for the treatment of cardiogenic shock. This article reports the successful treatment of cardiogenic shock caused by AlP poisoning in a 17-year-old man and a 21-year-old woman using the IABP procedure.

Keywords

Aluminum phosphide Phosphine Poisoning Cardiotoxicity Cardiogenic shock Intraaortic balloon pump 

Notes

Acknowledgements

The authors want to convey an appreciation of Dr. George Sam Wang for his nice comments in editing the manuscript.

Author Contributions

All authors equally contributed in collecting data and writing manuscript and revision. All the authors have read and approved the final manuscript.

Funding

It is the outcome of an in-house financially non-supported study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study involved human data and was conducted in strict accordance with the Declaration of Helsinki.

Informed Consent

Consent for publication of these two cases was obtained.

References

  1. 1.
    Mostafazadeh, B., & Farzaneh, E. (2012). A novel protocol for gastric lavage in patients with aluminum phosphide poisoning: A double-blind study. Acta Medica Iranica, 50(8), 530–534.Google Scholar
  2. 2.
    Mehrpour, O., Keyler, D., & Shadnia, S. (2009). Comment on Aluminum and zinc phosphide poisoning. Clinical Toxicology, 47(8), 838–839.CrossRefGoogle Scholar
  3. 3.
    Bashardoust, B., Farzaneh, E., Habibzadeh, A., & Sadeghi, M. S. S. (2017). Successful treatment of severe metabolic acidosis due to acute aluminum phosphide poisoning with peritoneal dialysis: A report of 2 cases. Iranian Journal of Kidney Diseases, 11(2), 165.Google Scholar
  4. 4.
    Navabi, S. M., Navabi, J., Aghaei, A., Shaahmadi, Z., & Heydari, R. (2018) Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: Characteristics and predictive factors. Epidemiology and Health, 40, e2018022.CrossRefGoogle Scholar
  5. 5.
    Goharbari, M., Taghaddosinejad, F., Arefi, M., Sharifzadeh, M., Mojtahedzadeh, M., Nikfar, S., et al. (2018). Therapeutic effects of oral liothyronine on aluminum phosphide poisoning as an adjuvant therapy: A clinical trial. Human & Experimental Toxicology, 37(2), 107–117.CrossRefGoogle Scholar
  6. 6.
    Mehrpour, O., & Singh, S. (2010). Rice tablet poisoning: A major concern in Iranian population. Human and Experimental Toxicology, 29(8), 701.CrossRefGoogle Scholar
  7. 7.
    Farzaneh, E., Ghobadi, H., Akbarifard, M., Nakhaee, S., Amirabadizadeh, A., Akhavanakbari, G., et al. (2018) Prognostic factors in acute aluminium phosphide poisoning: A risk-prediction nomogram approach. Basic & Clinical Pharmacology & Toxicology, 123(3), 347–355.CrossRefGoogle Scholar
  8. 8.
    Alinejad, S., Zamani, N., Abdollahi, M., & Mehrpour, O. (2017). A narrative review of acute adult poisoning in Iran. Iranian Journal of Medical Sciences, 42(4), 327.Google Scholar
  9. 9.
    Price, N. R., Mills, K. A., & Humphries, L. A. (1982). Phosphine toxicity and catalase activity in susceptible and resistant strains of the lesser grain borer (Rhyzopertha dominica). Comparative Biochemistry and Physiology Part C Comparative Pharmacology, 73(2), 411–413.CrossRefGoogle Scholar
  10. 10.
    Mehrpour, O., & Gurjar, M. (2017). Cardiogenic shock: The main cause of mortality in acute aluminum phosphide poisoning. Indian Journal of Critical Care Medicine, 21(4), 246–247.Google Scholar
  11. 11.
    Mehrpour, O., Farzaneh, E., & Abdollahi, M. (2011). Successful treatment of aluminum phosphide poisoning with digoxin: A case report and review of literature. International Journal of Pharmacology, 7(7), 761–764.CrossRefGoogle Scholar
  12. 12.
    Siddaiah, L. M., Adhyapak, S. M., Jaydev, S. M., Shetty, G. G., Varghese, K., Patil, C. B., et al. (2009). Intra-aortic balloon pump in toxic myocarditis due to aluminum phosphide poisoning. Journal of Medical Toxicology, 5(2), 80–83.CrossRefGoogle Scholar
  13. 13.
    Pajoumand, A., Jalali, N., Abdollah, M., & Shadnia, S. (2002). Survival following severe aluminium phosphide poisoning. Journal of Pharmacy Practice and Research, 32(4), 297–299.CrossRefGoogle Scholar
  14. 14.
    Abdollahi, M., Ranjbar, A., Shadnia, S., Nikfar, S., & Rezaiee, A. (2004). Pesticides and oxidative stress: A review. Medical Science Monitor, 10(6), RA141–RA14A7.Google Scholar
  15. 15.
    Proudfoot, A. T. (2009). Aluminium and zinc phosphide poisoning. Clinical Toxicology, 47(2), 89–100.CrossRefGoogle Scholar
  16. 16.
    Bhasin, P., Mital, H., & Mitra, A. (1991). An echocardiographic study in aluminium phosphide poisoning. The Journal of the Association of Physicians of India, 39, 851.Google Scholar
  17. 17.
    Katira, R., Elhence, G., Mehrotra, M., Srivastava, S., Mitra, A., Agarwala, R., et al. (1990). A study of aluminum phosphide (AlP) poisoning with special reference to electrocardiographic changes. The Journal of the Association of Physicians of India, 38(7), 471–473.Google Scholar
  18. 18.
    Rahbar Taromsari, M., Teymourpour, P., & Jahanbakhsh, R. (2011). Survey the histopathological findings in autopsy of poisoned patients with rice tablet (aluminium phosphide). Journal of Guilan University of Medical Sciences, 19(76), 56–63.Google Scholar
  19. 19.
    Mehrpour, O., Dolati, M., Soltaninejad, K., Shadnia, S., & Nazparvar, B. (2008). Evaluation of histopathological changes in fatal aluminum phosphide poisoning. Indian Journal of Forensic Medicine &Toxicology, 2(2), 34–36.Google Scholar
  20. 20.
    Arora, B., Punia, R., Kalra, R., Chugh, S., & Arora, D. (1995). Histopathological changes in aluminium phosphide poisoning. Journal of the Indian Medical Association, 93(10), 380–381.Google Scholar
  21. 21.
    Sinha, U., Kapoor, A., Singh, A., Gupta, A., & Mehrotra, R. (2005). Histopathological changes in cases of aluminium phosphide poisoning. Indian Journal of Pathology & Microbiology, 48(2), 177–180.Google Scholar
  22. 22.
    Sharma, A., Sharma, A., Acharya, A., Aryal, D., Rajbanshi, B. G., Bhattarai, P. R., et al. (2018). Extracorporeal membrane oxygenation in aluminum phosphide poisoning in Nepal: A case report. Journal of Medical Case Reports, 12(1), 311.CrossRefGoogle Scholar
  23. 23.
    Mohan, B., Singh, B., Gupta, V., Ralhan, S., Gupta, D., Puri, S., et al. (2016). Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: An observational study. Indian Heart Journal, 68(3), 295–301.CrossRefGoogle Scholar
  24. 24.
    Mohan, B., Gupta, V., Ralhan, S., Gupta, D., Puri, S., Wander, G. S., et al. (2015). Role of extracorporeal membrane oxygenation in aluminum phosphide poisoning–induced reversible myocardial dysfunction: A novel therapeutic modality. The Journal of Emergency Medicine, 49(5), 651–656.CrossRefGoogle Scholar
  25. 25.
    Akkaoui, M., Achour, S., Abidi, K., Himdi, B., Madani, A., Zeggwagh, A. A., et al. (2007). Reversible myocardial injury associated with aluminum phosphide poisoning. Clinical Toxicology, 45(6), 728–731.CrossRefGoogle Scholar
  26. 26.
    Gupta, M., Malik, A., & Sharma, V. (1995). Cardiovascular manifestations in aluminium phosphide poisoning with special reference to echocardiographic changes. The Journal of the Association of Physicians of India, 43(11), 773–780.Google Scholar
  27. 27.
    Ahmadi, J., Joukar, S., Anani, H., & Karami-Mohajeri, S. (2018). Dihydroxyacetone as a definitive treatment for aluminium phosphide poisoning in rats. Archives of Industrial Hygiene and Toxicology, 69(2), 169–177.CrossRefGoogle Scholar
  28. 28.
    Changal, K. H., Latief, M., Parry, M., & Abbas, F. (2017). Aluminium phosphide poisoning with severe cardiac dysfunction and the role of digoxin. BMJ Case Reports, 2017, bcr–2017.Google Scholar
  29. 29.
    El Hangouche, A. J., Fennich, H., Alaika, O., Dakka, T., Raissouni, Z., Oukerraj, L., et al. (2017) Reversible myocardial injury and intraventricular thrombus associated with aluminium phosphide poisoning. Case Reports in Cardiology. 2017, 6287015.CrossRefGoogle Scholar
  30. 30.
    Chugh, S., Ram, S., Sharma, A., Arora, B., Saini, A., & Malhotra, K. (1989). Adrenocortical involvement in aluminium phosphide poisoning. The Indian Journal of Medical Research, 90, 289–294.Google Scholar
  31. 31.
    Bagheri-Moghaddam, A., Abbaspour, H., Tajoddini, S., Mohammadzadeh, V., Moinipour, A., & Dadpour, B. (2018) Using intra-aortic balloon pump for management of cardiogenic shock following aluminum phosphide poisoning; Report of 3 cases. Emergency, 6(1), e3.Google Scholar
  32. 32.
    Oghabian, Z., & Mehrpour, O. (2016). Treatment of aluminium phosphide poisoning with a combination of intravenous glucagon, digoxin and antioxidant agents. Sultan Qaboos University Medical Journal, 16(3), e352.CrossRefGoogle Scholar
  33. 33.
    Thiele, H., Ohman, E. M., Desch, S., Eitel, I., & de Waha, S. (2015). Management of cardiogenic shock. European Heart Journal, 36(20), 1223–1230.CrossRefGoogle Scholar
  34. 34.
    Gilotra, N. A., & Stevens, G. R. (2014). Temporary mechanical circulatory support: A review of the options, indications, and outcomes. Clinical Medicine Insights: Cardiology, 8, 75–85.Google Scholar
  35. 35.
    Lawson, W. E., & Koo, M. (2015). Percutaneous ventricular assist devices and ECMO in the management of acute decompensated heart failure. Clinical Medicine Insights: Cardiology, 9, 41–48.Google Scholar
  36. 36.
    Helleu, B., Auffret, V., Bedossa, M., Gilard, M., Letocart, V., Chassaing, S., et al. (2018). Current indications for the intra-aortic balloon pump: The CP-GARO registry. Archives of Cardiovascular Diseases, 111(12), 739–748.CrossRefGoogle Scholar
  37. 37.
    Virk, S. A., Keren, A., John, R. M., Santageli, P., Eslick, A., & Kumar, S. (2019). Mechanical circulatory support during catheter ablation of ventricular tachycardia: Indications and options. Heart, Lung and Circulation, 28(1), 134–145.CrossRefGoogle Scholar
  38. 38.
    Wnek, W. (2003). The use of intra-aortic balloon counterpulsation in the treatment of severe hemodynamic instability from myocardial depressant drug overdose. Przeglad Lekarski, 60(4), 274–276.Google Scholar
  39. 39.
    Mehrpour, O., Amouzeshi, A., Dadpour, B., Oghabian, Z., Zamani, N., Amini, S., et al. (2014). Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology, 65(1), 121–127.CrossRefGoogle Scholar
  40. 40.
    Collison, S. P., & Dagar, K. S. (2007). The role of the Intra-aortic balloon pump in supporting children with acute cardiac failure. Postgraduate Medical Journal, 83(979), 308–311.CrossRefGoogle Scholar
  41. 41.
    Melanson, P., Shih, R., & DeRoos, F. (1993). Intra-aortic balloon counterpulsation in calcium channel blocker overdose. Veterinary and Human Toxicology, 35, 345.Google Scholar
  42. 42.
    Lane, A. S., Woodward, A. C., & Goldman, M. R. (1987). Massive propranolol overdose poorly responsive to pharmacologic therapy: Use of the intra-aortic balloon pump. Annals of Emergency Medicine, 16(12), 1381–1383.CrossRefGoogle Scholar
  43. 43.
    Gillard, P., & Laurent, M. (1999). Dextropropoxyphene-induced cardiogenic shock: Treatment with intra-aortic balloon pump and milrinone. Intensive Care Medicine, 25(3), A335–A335.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Rocky Mountain Poison and Drug Center, Denver HealthDenverUSA
  2. 2.Medical Toxicology and Drug Abuse Research Center (MTDRC)BirjandIran
  3. 3.Metabolic Syndrome Research CenterMashhad University of Medical SciencesMashhadIran
  4. 4.Cardiovascular Diseases Research CenterBirjand University of Medical SciencesBirjandIran

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