Aluminium phosphide poisoning: haemodynamic observations

Area of Science:

• Cardiology
• Toxicology
• Critical Care Medicine

Background:

• Aluminium phosphide (AlP) poisoning is a significant cause of mortality, particularly in agricultural regions.
• Understanding the haemodynamic profile of AlP poisoning is crucial for effective management.
• Previous studies have highlighted the severity of AlP poisoning, but detailed haemodynamic data are limited.

Purpose of the Study:

• To investigate the haemodynamic derangements in patients with aluminium phosphide poisoning.
• To identify haemodynamic parameters associated with mortality in AlP poisoning.
• To evaluate the potential benefit of fluid resuscitation in managing AlP poisoning.

Main Methods:

• Prospective observational study involving 25 patients with confirmed aluminium phosphide poisoning.
• Comprehensive haemodynamic monitoring including mean arterial pressure, cardiac output, systemic vascular resistance, and intracardiac pressures.
• Comparison of haemodynamic parameters between survivors and non-survivors.

Main Results:

• Patients exhibited severe hypotension (mean arterial pressure 62.7 +/- 19.3 mmHg) and reduced cardiac output (2.13 +/- 0.9 lit/min/m2).
• Systemic vascular resistance was only moderately elevated, and pulmonary artery pressures remained normal despite pulmonary oedema.
• Lower cardiac output was significantly associated with mortality (p < 0.05), with 52% of deaths occurring in this subgroup.
• Saline infusion demonstrated a potential to improve haemodynamics in some patients.

Conclusions:

• Aluminium phosphide poisoning is characterized by profound hypotension and reduced cardiac output with preserved systemic vascular resistance.
• Cardiac output appears to be a critical determinant of survival in AlP poisoning.
• Judicious early fluid administration may be a beneficial therapeutic strategy in managing haemodynamic instability in AlP poisoning.