Phosphine inhalation, case series of domestic unintentional poisoning commonly used as anti-bed bug chemical from a low income country (original) (raw)
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Phosphine Gas Poisoning in Children: A Case Series Study from Tertiary Health Care Center of Karachi, Pakistan, 2022
Phosphine poisoning is an uncommon but hazardous public health issue. It is widely used as chemical insecticide and pesticide domestically and exposure to this chemical, mostly accidental among children, may lead to fatal symptoms if not managed immediately. Previous studies have explored the mechanism of its deleterious effect. However, literature on presentation of phosphine poisoning is sparse. We observed a short case series form a family who was exposed to phosphine gas from aluminum phosphide tablets that were used for fumigation purpose in bedroom. Family locked the house for six hours only and then used that bedroom without proper cleaning and removal of the chemical from the house. No adequate aeration of the room before use was done. Detail history from parents was taken and clinical details were identified however further details were noted from their medical records. We identified three cases of phosphine poisoning during this exposure. One of the babies was brought dead, with history of acute onset nausea and vomiting followed by increasing paleness, sweating and questionable seizure episode along with loss of body posture and unresponsiveness. Other two girls presented with generalized weakness, nausea, vomiting and lethargy since morning. Both sisters were admitted to pediatric intensive care unit for less than one week and were managed symptomatically along with magnesium sulfate. The objective of this case series study is to bring in attention of the families, health care community and the stake holders for the need to replace harmful insecticide fumigation practices with the safer ones, as phosphine gas can cause late onset of clinical feature and sudden death, probably because of fatal myocarditis as observed by echocardiography in both survived girls. Whenever fumigation is done parents/family members be provided with proper written guidelines that along with fumigation process and reuse of the house must mention possible side effects. Moreover, to increase public awareness, proper labeling and precautions should be written on all commonly sold pesticides and the constituent of hazardous compounds they contain.
Pathological changes induced by phosphine poisoning: a study on 8 children
International Journal Of Legal Medicine, 2019
Aluminum phosphide (ALP) has been extensively used as an economical and effective insecticide, rodenticide, and fumigant. The active ingredient of ALP is phosphine (PH 3), the use of which can lead to accidental inhalation and mass poisoning with high mortality. Exposure to PH 3 will give rise to global damage in the human body. This study reviewed 4 fatal accidents including 8 children with PH 3 poisoning and aimed to determine the pathological changes that resulted from exposure to PH 3 and, secondly, aimed to determine whether oxidative stress was involved in PH 3-induced neurotoxicity using histopathological and immunohistochemistry (IHC) methods. After focusing on the pathological changes on the major organs, we found severe damage induced by PH 3 in many systems, especially the neurological system, including neuronal, axonal, and vascular injuries as well as oxidative damage with increased expression of 4-hydroxy-2trans-nonenal (4HNE), 8-hydroxy-2'-deoxyguanosine (8-OH-dG), and 3-nitrotyrosine (3-NT) in the brain, which indicated that oxidative stress was a crucial mechanism for neuronal death in PH 3 toxicity. Moreover, we observed severe myocardial and hepatocellular fatty degeneration in the tissues of the heart and liver. We considered that these characteristic changes are a suggestive sign of PH 3 poisoning and partly explained the toxic mechanism of PH 3 (inhibition of mitochondrial oxidative phosphorylation). We hope that this research could improve the understanding of the toxicity of PH 3 in both forensic and clinical practice.
Familial Poisoning by Phosphine
Lethal intoxications with phosphine belong to rare cases in Poland. Most frequently they involve suicidal intake of metal phospides and accidental intoxications due to gas inhalation. The case of acute intoxication with phosphine in presented, affecting two persons: a 14-month-old child, who died, and the surviving mother. The intoxication took place on a farm and phosphine was released from toxic aluminium phosphide, a component of Quickphos Pellets 56GE preparation, widely used for disinsection of empty facilities for storage of grain and other alimentary products. Autopsy of the 14-month-old child demonstrated cerebral edema and pulmonary edema and excluded other pathology as the cause of death. Toxicological tests demonstrated only elevated levels of phosphorus. The entire clinical pattern of intoxication permitted to conclude that the cause of 14-month-old child’s death involved acute intoxication with phosphine, in the mother a subacute intoxication with phosphine was diagnosed. The survival of the mother and death of her 14-month-old child reflected their very different body weight and distinct resistance to toxic effect of phosphine. Keywords: Phosphine Intoxication, Aluminum Phosphide, Pesticides, Death of a Small Child.
IP innovative publication pvt. ltd, 2019
Introduction: Nowadays, organophosphate (OP) compounds are widely used in agricultural field as an insecticide. Toxicity with these compounds is owing to inhibition of acetylcholinesterase enzyme. Patients are presented with muscarinic and nicotinic side effects. Objective: To study the clinical aspect of OP poisoning in detail with hospital stay, clinical course, complication, and recovery and mortality in OP poisoning. Materials and Methods: This study was done at Gandhi Medical College and in association with ayan Institute of Medical Sciences, Hyderabad India, comprising 271 cases of OP poisoning. After taking written consent, personal history of the patients was taken. Then, a detailed history regarding poison and clinical symptoms was taken. Then, general and systematic examinations of patients were carried out, and blood samples were sent for investigations. We followed up the patients till discharge or death. Result: In our study, maximum incidence of OP poisoning was in between 21-30 years age group (40%), and male to female ratio was 4:1. Clinical symptoms such as unconsciousness, stupor (90.47%), vomiting (9.42%), convulsions (66.00%) are froth at mouth and nostrils (62.00%) and the common symptoms whereas constricted pupils (85.71%), pulmonary oedema (88.00%), Tachycardia (76.17%), hypotension (28.57%)are the common signs noted in this series of cases who were treated in the hospital and where the hospital records were available. Post-mortem appearances no specific anatomic changes are found in acute poisoning the changes are suggestive os asphyxia. The appearances are external or internal. The histopathological findings are not significant. Histopathological examination of tissue revealed usually congestion of brain, oedema and congestion of lungs and fatty degeneration in liver and in some cases cloudy swelling and tubular necrosis in kidneys. Conclusion: Detailed history and thorough clinical examination of patients are helpful in diagnosing the patients of OP poisoning. Life-threatening complications occurred in these patients. Early detection and immediate treatment in intensive care units with injections atropine and PAM can increase the chances of survival rate of patients.
Analysis of Organophosphorus compound poisoning patients attending CMS-TH, Bharatpur, Nepal
Journal of College of Medical Sciences-Nepal, 2012
Organophosphorus (OP) compound poisoning is a medical emergency. It is important to know its nature, clinical presentation, severity and outcome in order to take up appropriate measures including proper planning, treatment and prevention. This study was aimed to assess the clinical profile of organophosphorus poisoning. This is a prospective hospital based study conducted at CMS-T.H., Bharatpur, Nepal. The study included 111 patients of organophosphorus poisoning during the period November 2008 to July 2011. The incidence was commoner in females than males with female:male ratio being 1.47:1. Majority of the patients(58.56%) belonged to the age group 16 to 30 years with female predominance(2.25:1). Modes of poisoning were suicidal in the majority (94.59%), accidental in 4.50%. and homicidal in 0.90%. Psychiatric problems were the major precipitating factors. Majority of patients(62.16%) had moderate poisoning (POP scale: 4-7).On admission, dyselectrolytemia and respiratory failure w...
Clinicoepidemiological Profile of Organophosphorus Poisoning in a Tertiary Care Center
International journal of contemporary medical research, 2019
Introduction: Organophosphorus compounds are widely used as insecticides. Organophosphorus poisoning has a significant morbidity and mortality and is a common occurrence due to their easy accessibility. Study aimed to assess clinicoepidemiological profile of organophosphorus poisoning. Material and methods: Our study was a hospital based prospective study conducted over a period of two years involving all the patients of organophosphorus (OP) poisoning, admitted in the medical emergency of the hospital. These patients were evaluated for demographic and clinical profile and followed till the time of discharge or death. Results: 102 cases of OP poisoning were admitted, majority belonged to the age group of 15-25 years (54.9%) and were of rural origin (84.3%). Females (67.64%) outnumbered males. 97 cases had taken it with suicidal intent. Miosis was the most consistent clinical feature (93.13%). 64 patients (62.7%) needed admission in ICU. Respiratory failure was the most common complication. Mortality rate of 14.7% was observed. Conclusion: OP compounds are ingested mostly with suicidal intent due to their easy availability mostly by young and productive population. Initial management and resuscitation in periphery is invaluable.
Phosphine poisoning in free-range local chickens: a case report
Veterinary Medicine and Science
Phosphine poisoning is rarely reported in poultry, and its diagnosis is a great challenge for veterinary toxicologists and pathologists. A case of phosphine toxicosis in local, free range chickens is reported. Fourteen dead chickens (age ≥6 months old) were presented to the veterinary clinic for necropsy. The history revealed that the chickens were normally fed with guinea corn grains, but were suspected to have been fed boiled rice laced with poison. The clinical signs observed were ruffled feathers, somnolence, anorexia and high mortality. The disease ran a 2-day course with mortality pattern of four chickens the first day, six overnight and 14 the following day. Necropsy findings showed generalized vascular congestion and haemorrhage in the lungs and visceral organs, with the crop and gizzard filled with guinea corn and rice grains and greenish-yellow faecal material in the intestinal lumen. The presence of widespread congestion and petechial haemorrhages on visceral organs with the microscopic pulmonary congestion, and diffuse intraparabronchial presence of air sac macrophages, strongly suggested an acute toxic cause of death. Chemical tests on the crop contents of the dead chickens were positive for phosphine gas. This report will contribute to a better understanding of the clinical signs and lesions presented in cases of acute phosphide rodenticide exposure in domestic chickens, with a brief review of the forensic literature.
Pattern of Poisoning Cases in Bir Hospital
Journal of Institute of Medicine, 2007
Background: Poisoning is one of the major causes of hospitalization through emergency and is a major public health problem in the country. For starting preventive measures, information on nature and extent of poisoning is required. For some years, there has been no study on poisoning at Bir hospital. Objectives: To find out the patient profile, the common poisons and outcome of poisoning cases. Materials and Methods: A retrospective analysis of all acute poisoning cases admitted to the emergency department of Bir Hospital from January 2005 to June 2005 was done to study the pattern of acute poisoning. Data on age, sex, time elapsed after intake, circumstances of poisoning, name of the poisonous substance, actual use, chemical type, hospitalization days, severity and outcome were collected and analyzed. Results: The age of the patients varied from 16 to 65 years. The male female ratio was 1:1.3. More than three-fourth (76.8%) of the female patients were from 16 to 25 years age group. Similarly, 46.5% of the male patients were from 16 to 25 years age group. In more than 25 years of age, there was male predominance in all the age group. The common insecticides used for poisoning were organophosphorus compounds mainly Methyl Parathion (Metacid) and Dichlorovos (Nuvan). Paracetamol alone or combination preparations with antihistamines were the most common analgesic used. Benzodiazepines were the most commonly used anxiolytics. Ninety-seven percent of cases were intentional poisoning for suicidal attempt. Most of the cases (61.6%) had arrived hospital within 3 hours after exposure to the poison. The hospital stay of the admitted patients with poisoning ranged from one to sixteen days. The mean hospital stay was 5.9 days. During the hospital stay, six (6.0%) cases were managed in Intensive Care Unit (ICU) service. In this study, only 3% cases had mortality. There were 5 cases of Aluminium Phosphide poisoning but surprisingly, none of them died from this highly toxic poison. Conclusion: Suicide among adolescents and young adults is a common public health problem. Patients with intentional poisoning must undergo psychiatric consultation during their stay in the hospital for the treatment poisoning. This will minimize the risk of next attempt of self harm. In addition, strict rules must be followed regarding sale of psychotropic medicines and pesticides. Effective clinical management of poisoning can minimize the mortality.
IOSR Journal of Dental and Medical Sciences
Introduction: The rising incidences of Poisoning with prevalence of certain groups of poisons in this particular geographical area has prompted us to undertake this study to know the etiological patterns, epidemiological aspects & their outcomes. The observations of various other authors are compared in scientific discussion. Materials and methods: This study is conducted and designed as retrospective study with 241 subjects, who came to our hospital in past 2 years. Results: Among the 241 subjects males were more in number which is 61.8%. The most common poison consumed has been found to be organo phosphorous compounds which is 18.6% followed by other insecticides (14.1%). With respects to occupation farmers have been found to be more in number which is 25.3%. Recovery rate of drug over dose(24) and acid poisoning(10) are 100% and the mortality rate is seen to be more with Paraquat poisoning which is 54.50%. Accidental poisoning is seen in children below 10 years which is 5.4%. The mortality rate and recovery rate of all poisonings are 6.2% and 83.8% respectively. Conclusion: The majority of poisonings were with organo phosphorous compounds, for suicidal purposes, in young age group, and in males. In our study, the three most common agents causing poisoning were organo phosphorous compounds, other insecticides and rodenticides.
International Journal of Advances in Medicine, 2017
Background: Organophosphates (OP) are commonly used and potentially fatal insecticides. Given the unrestricted availability and widespread use, OP poisoning is very much common following either accidental or intentional exposures. Many parameters are proposed to predict outcome, yet there is no consensus about these parameters. This study aimed to investigate different factors associate with morbidity and mortality in rural population that can help in identifying patients in need of intensive care and treatment to prevent deaths.Methods: This was a cross-sectional observational study of 323 patients, admitted to the tertiary care rural public hospital with OP poisoning between December 2015 to November 2016.Results: Of the 323 patients studied, 62.85% were male, 227 (70.27%) were suicides, 241 (74.61%) ingested OP compounds, 40 (12.38%) patients developed intermediate syndrome and 56 (17.34%) died. There were statistically significant differences between ventilatory support group an...