Therapeutic Effect of Glucose-Insulin-Potassium (GIK) Infusion Therapy in the Treatment of Acute Aluminum Phosphide Poisoning: An Institutional Study

Abstract

Background: Acute aluminum phosphide (ALP) poisoning presents a significant global medical challenge, particularly in regions where it is commonly used as a pesticide. Despite medical advancements, mortality rates from ALP poisoning remain high. Glucose-insulin-potassium (GIK) infusion therapy has emerged as a potential treatment for ALP poisoning due to its ability to counteract its toxic effects on metabolism and heart function. However, there is limited institutional data on the effectiveness of GIK therapy in treating ALP poisoning. Hence, this study aims to evaluate the therapeutic impact of GIK infusion therapy in managing acute ALP poisoning within our institution. The research aims to provide valuable insights into the efficacy of GIK therapy, with the potential to enhance patient outcomes and guide clinical practices in ALP poisoning management.

Materials and methods: This cross-sectional study was conducted at the Resuscitation Unit of the Emergency Department of Lady Reading Hospital (LRH), Peshawar, from February 1, 2021, to May 31, 2021, using convenient sampling of all patients with aluminum phosphide (ALP) poisoning meeting the inclusion criteria. The study group included 15 ALP poisoning cases treated with GIK infusion therapy combined with standard supportive measures and examined individuals with ALP poisoning admitted to the Resuscitation Unit during a specific period, comparing their outcomes to those observed before the introduction of GIK therapy. Randomization was based on time span, as GIK therapy was introduced in October 2020. Inclusion criteria encompassed a confirmed history of ALP poisoning with at least one deranged vital parameter, including patients of all genders and age groups. At the same time, we excluded patients with normal blood pressure on arrival, no deterioration four hours post-presentation, or those who expired before arrival. Data on hospital registration number, gender, age, arrival date, serial blood pressures, supportive measures, GIK infusion usage, and outcomes were analyzed using SPSS version 20.0 to assess the therapeutic impact of GIK infusion therapy.

Results: Among 15 ALP poisoning cases, 20% resulted in fatalities, with 80% either transferred to acute units (40%). Mortality was highest (66%) in the 20-29 age group, contrasting with no deaths in the 1-19 age group. Additionally, 33% mortality occurred in the 30-39 age group. Only 25% of patients with blood pressure below 91/61 succumbed. GIK therapy led to hemodynamic stability, prolonged unit stays, and increased transfers. Patients in acute units had longer stays compared to discharged or expired cases, reflecting the nuanced dynamics of ALP poisoning management.

Conclusion: This research aimed to systematically examine the effect of GIK infusion therapy on ALP poisoning cases at LRH, Peshawar, offering insights into its effectiveness compared to previous cases and reducing mortality by enhancing cardiac function.

Keywords: acute aluminium phosphide poisoning; acute poisoning; aluminium phosphide; aluminium phosphide poisoning; glucose insulin potassium infusion; pesticide causing cytochrome oxidase inhibition; pesticide poisoning.

Figure 1. Length of hospital stay and patient outcome

Figure 2. Outcome distribution of confirmed ALP poisoning cases: visualization of fatalities and patient dispositions