Vaidyanathan R.1 , Adarsh S.P.2 , Ashoka H.G.3 , Noor Rubina Ahmedi4
BACKGROUND We wanted to do a retrospective study of the distribution pattern, outcome with possible predictors affecting the mortality in patients who had consumed aluminium phosphide and were admitted in our ICU and compare difference in mortality among the two different regimens used during two different time frames. METHODS 63 patients who were admitted to the ICU between Jan 2011 to Dec 2017 after consumption of aluminium phosphide were studied. Baseline clinical assessment and routine investigations including complete blood counts, renal function tests, electrolytes, ECG, ABG and 2D Echo were done. For the first 4 years from 2011 - 2014, a standard regimen based mainly on supportive care was followed. For the remaining 3 years from 2015 - 2017, an aggressive regimen involving coconut oil, ascorbic acid, magnesium, NaHCO3 and supportive measures were followed. RESULTS Out of the 63 patients admitted during the study period, 16 patients died, and the remaining 47 patients survived. Serum lactate, MAP (Mean Arterial Pressure) at admission, MAP after 24 hours, and presence of arrhythmias were found to be significantly associated with both need for ventilatory support and mortality. The time elapsed since consumption of compound was not found to be associated with either mortality or the need for ventilatory support. On subgroup analysis of two different regimens followed, one with only supportive measures and the other with coconut oil, ascorbic acid, magnesium and sodium bicarbonate, it was found that there was no significant difference with either of the regimens with respect to mortality or need for ventilatory support. (p>0.05) CONCLUSIONS The overall treatment in these cases is highly favourable as the mortality is 25.39% compared to the 40 - 80% mortality reported in literature. Serum lactate, Mean Arterial Pressure (MAP) at admission, MAP after 24 hours and presence of arrhythmias on admission were found to be significantly associated with mortality though none of them were found to predict mortality independently. Coconut oilbased regimens are very popular in the management of aluminium phosphide poisoning. However, in our study it didn’t show any added advantage in terms of either ventilatory requirement or mortality difference over conventional supportive measures.
