Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 63, Num. 12, 2009, pp. 561-562

Indian Journal of Medical Sciences, Vol. 63, No. 12, December, 2009, pp. 561-562

Letter To Editor

Aluminum phosphide poisoning

Sharma Vishal, Sharma Alka

Department of Medicine, University College of Medical Sciences, Delhi
Correspondence Address:University College of Medical Sciences, Delhi
docvishalsharma@gmail.com

Code Number: ms09102

PMID: 20160383

DOI: 10.4103/0019-5359.59991

Sir,

Aluminum phosphide poisoning is an important medical emergency which physicians in the developing countries, including India, deal with very commonly. While the authors have commented on the effects of various clinical and biochemical parameters on outcome, some other factors might have played a role in determining the prognosis. ^[1]

It would be of interest to know if the tablets were fresh or exposed, since exposed tablets lose their lethality and may cause less severe manifestations. Administration of magnesium sulfate has been shown to improve outcome, possibly by dual action of membrane stabilization and correction of hypomagnese mia. ^[2] Since only 9 out of the 49 patients received magnesium sulfate, it will be interesting to know the dosage used and if the administration of magnesium sulfate made any difference to the outcome.

Also, the authors have commented on the presence of myocardial ischemia. It would be of interest to know how this was diagnosed, since ECG changes of severe toxic myocarditis as seen in aluminum phosphide poisoning can easily mimic those of ischemia. ^[3] Probably the changes authors have mentioned are a result of severe myocarditis rather than ischemia per se. It would also be of interest to know the number of patients who had altered sensorium and the cause of altered sensorium.

References

1.	Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci 2009;63:227-34.  Back to cited text no. 1  [PUBMED]
2.	Chugh SN, Kumar P, Aggarwal HK, Sharma A, Mahajan SK, Malhotra KC. Efficacy of magnesium sulphate in aluminium phosphide poisoning--comparison of two different dose schedules. J Assoc Physicians India 1994;42:373-5.   Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.	Soltaninejad K, Shadnia S, Ziyapour B, Brent J. Aluminum phosphide intoxication mimicking ischemic heart disease led to unjustified treatment with streptokinase. Clin Toxicol (Phila) 2009;47:908-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]

Copyright 2009 - Indian Journal of Medical Sciences