Acute aluminium phosphide poisoning: Can we predict mortality?

In India, acute aluminium phosphide poisoning (AAlPP) is a serious health care problem. This study aimed to determine the characteristics of AAlPP and the predictors of mortality at the time of patients' admission. We studied consecutive admissions of patients with AAlPP admitted to the intensive care unit (ICU) between November 2004 and October 2006. We noted 38 parameters at admission to the hospital and the ICU and compared survivor and non-survivor groups. A total of 27 patients were enrolled comprising5 females and 22 males and the mean ingested dose of poison was 0.75 ± 0.745 grams. Hypotension was noted in 24 patients (89%) at admission and electrocardiogram abnormalities were noted in 13 patients (48.1%). The mean pH on admission was 7.20 ± 0.14 and the mean bicarbonate concentration was 12.32 ± 5.45 mmol/ L. The mortality from AAlPP was 59.3%. We found the following factors to be associated with an increased risk of mortality: a serum creatinine concentration of more than 1.0 mg % (P = 0.01), pH value less than 7.2 (P = 0.014), serum bicarbonate value less than 15 mmol/L (P = 0.048), need for mechanical ventilation (P = 0.045), need for vasoactive drugs like dobutamine (P = 0.027) and nor adrenaline (P = 0.048) and a low APACHE II score at admission (P = 0.019). AAlPP causes high mortality primarily due to early haemodynamic failure and multi-organ dysfunction.