Medknow Publications on behalf of Indian Journal of Medical Sciences Trust
Abstract
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