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. 562-563

Indian Journal of Medical Sciences, Vol. 63, No. 12, December, 2009, pp. 562-563

Letter To Editor

Authors reply

Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA

Medical ICU, Ibn Sina Hospital, Rabat
Correspondence Address:Service de Réanimation Médicale et de Toxicologie Clinique, Hôpital Ibn Sina, Rabat
aazeggwagh@invivo.edu

Code Number: ms09103

Sir,

The comments are very interesting and require clarification. It is true that the quality of tablets (fresh or exposed) may influence the toxicity of aluminum phosphide. In our retrospective study, we unfortunately could not specify this information with regard to all patients. ^[1] Moreover, people who attempt suicide buy tablets usually from the traditional drugstore, and we ignore the storage conditions of the toxic drugs at the drugstore. Regarding the dosage used for magnesium sulphate, it was prescribed as a bolus of 1 g followed by 1 g/h for 3 hours and then 1 g/6 h. Magnesium sulfate was used in only 9 patients (5 in the group of survivors and 4 in the group that died). No differences were observed between the group with magnesium sulfate and the group without in terms of severity (Apache 2: 5 ± 5 vs. 6 ± 6), shock (33.3% vs. 44.7%), use of mechanical ventilation (22.2% vs. 45%) and mortality (50% vs. 44.4%). Indeed, magnesium sulfate has always been associated with vasoactive drugs (100% vs. 45%, P= .002). Regarding the ECG changes, even if the postmortem biopsy revealed myocardial necrosis in one patient, we fully agree with the fact that severe myocarditis can mimic myocardial ischemia. In our series, the term myocardial ischemia has been used to describe the observed electrical changes. Finally, concerning the alteration of consciousness, it was noted in 8 patients; 7 of them died. The Glasgow coma scale (GCS) was 8 in 2 patients, 11 in 2 patients, 13 in 2 patients and 14 in 2 patients. The cause of the alteration of consciousness is not clear.We believe it was largely due to the shock in 6 patients although the multivariate analysis showed that the shock and altered consciousness were independent factors. For 2 other patients without shock, the cause of the altered consciousness (GCS of survivor = 14 and non survivor = 13) was not clear. This may suggest that other mechanisms must be analyzed.

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]

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