Physicians' perspectives on different therapeutic approaches for aluminum phosphide poisoning and their relevant outcomes

Abstract

Background: Aluminum phosphide is a highly toxic pesticide that results in high mortality. To date, there is neither a definitive antidote nor a unified protocol for managing acute aluminum phosphide poisoning.

Objectives: This cross-sectional questionnaire-based study aims to explore different management approaches and rely on the expertise of Egyptian medical professionals to enhance the prognosis for acute aluminum phosphide poisoning.

Subjects and methods: A self-administered questionnaire was formulated and electronically distributed according to published literature and experience of senior physicians.

Results and conclusions: Responses were received from 151 physicians from 10 governorates. Management modalities were variable among respondents. Noradrenaline was used by 90.7% of respondents with no fixed-dose regimen. In all, 84.1% of participants utilized oil in gastrointestinal decontamination; paraffin oil was the most used solution. Overall, 92.1, 61.6, 46.4, and 34.4% of participants used sodium bicarbonate, proton pump inhibitors, IV magnesium sulfate, and antioxidants, respectively. Regarding the frequency of acute aluminum phosphide poisoning, 47% of participants managed these cases daily or a few times a week. Participants' responses denoted a poor prognosis of acute aluminum phosphide poisoning, and high percentages attributed the prognosis to exposure factors rather than treatment modalities. Statistical analysis revealed that using oil in gastrointestinal decontamination improved the outcome by 4.62-fold. Clinical toxicologists were more likely to rescue ≥ 30% of the cases about 3-fold (2.97) than other specialties. Clinical toxicologists used oil in gastrointestinal decontamination, magnesium sulfate, and antioxidant therapy and calculated base deficit before administration of sodium bicarbonate by 7.70-, 5.30-, 3.26-, and 2.08-fold than other specialties.

Keywords: Egypt; acute poisoning; aluminum phosphide; clinical toxicologist.

Fig. 1

CPR in acute AlP-intoxicated patients.

Fig. 2

Frequency of acute AlP poisoning cases managed by participating physicians (n = 151).

Fig. 3

Percentage of successfully managed AlP-intoxicated patients determined by participating physicians (n = 80).

Fig. 4

Participants’ responses regarding exposure-related factors and management strategies affecting the outcome of AlP-intoxicated patients (n = 151).