Prognostic Significance of Acid Base Disturbances among Patients with Acute Aluminum Phosphide Poisoning

Abstract

Background: Aluminum phosphide (ALP) is used to protect stored grains from rodents & pests. ALP poisoning is considered one of the significant public health problems which could occur accidentally, suicidal, or even occupational. The main presentations of acute ALP poisoning are gastrointestinal symptoms, profound circulatory collapse, arrhythmia, and electrolyte & acid-base disturbances. Objectives: The current study evaluated acid-base disturbances on admission as a simple outcome predictor in acute ALP poisoned patients. Patients & methods: 100 adult patients with acute ALP poisoning were included in this study. Patients with cardiovascular, chronic renal and liver diseases were excluded. Additionally, patients admitted with mixed intoxication or associated trauma and those who received any medications before admission were excluded from this study. Arterial blood gases (ABG) were done and analyzed to all included patients on admission before receiving any medications. Results: There was a significant positive correlation between pH value and pre-hospitalization period, systolic blood pressure (SBP), diastolic blood pressure (DBP), and period of hospital stay. A significant negative correlation existed between pH and dose of ALP, respiratory rate, and dose of required vasopressor. Bicarbonate level (HCO3) registered a significant positive correlation with SBP and DBP. Meanwhile, a significant negative correlation existed between HCO3 and both respiratory rate and dose of required vasopressor. There was a significant difference between survivors and non-survivors regarding pH, HCO3, PaCO2, and PaO2. Furthermore, there was a significant difference between patients who required and did not require mechanical ventilation considering pH, HCO3, and PaO2. Conclusion: It could be concluded that determining acid-base disturbance on admission in acute ALP poisoned patients is a simple, cheap, and reliable marker that may help to predict mortality and mechanical ventilation requirement.