Prognostic factors of acute aluminum phosphide poisoning

BACKGROUND: In Morocco, acute aluminum phosphide poisoning (AAlPP) is a serious health care problem. It results in high mortality rate despite the progress of critical care. AIMS: The present paper aims at determining the characteristics of AAlPP and evaluating its severity factors. SETTING AND DESIGN: We studied consecutive patients of AAlPP admitted to the medical intensive care unit (ICU) (Ibn Sina Hospital, Rabat, Morocco) between January 1992 and December 2007. MATERIALS AND METHODS: Around 50 parameters were collected, and a comparison was made between survivor and nonsurvivor groups. STATISTICAL ANALYSIS: Data were analyzed using Fisher exact test, Mann-Whitney U test and Cox regression model. RESULTS: Forty-nine patients were enrolled: 31 females and 18 males; their average age was 26+/-11 years. The ingested dose of aluminum phosphide was 1.2+/-0.7 g. Self-poisoning was observed in 47 cases, and the median of delay before admission to the hospital was 5.3 hours (range, 2.9-10 hours). Glasgow coma scale was 14+/-2. Shock was reported in 42.6% of the patients. pH was 7.1+/-0.4, and bicarbonate concentration was 16.3+/-8.8 mmol/L. Electrocardiogram abnormalities were noted in 28 (57%) cases. The mortality rate was 49% (24 cases). The prognostic factors were APACHE II (P=0.01), low Glasgow coma scale (P=0.022), shock (P=0.0003), electrocardiogram abnormalities (P=0.015), acute renal failure (P=0.026), low prothrombin rate (P=0.020), hyperleukocytosis (P=0.004), use of vasoactive drugs (P<0.001), use of mechanical ventilation (P=0.003). Multivariate analysis by logistic regression revealed that mortality in AAlPP correlated with shock (RR=3.82; 95% CI=1.12-13.38; P=0.036) and altered consciousness (RR=3.26; 95% CI=1.18-8.99; P=0.022). CONCLUSION: AAlPP is responsible for a high mortality, which is primarily due to hemodynamic failure.