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LETTER TO EDITOR
J Res Med Sci 2017,  22:94

The convergence of considerations in aluminum phosphide poisoning: The occurrence of injuries beyond the metabolic manifestations


Department of Clinical Toxicology, Bu Ali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

Date of Web Publication16-Aug-2017

Correspondence Address:
Seyed Mostafa Mirakbari
Department of Clinical Toxicology, Bu Ali Hospital, Qazvin University of Medical Sciences, Bu Ali Street, Qazvin 34137-86165
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrms.JRMS_313_17

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How to cite this article:
Mirakbari SM. The convergence of considerations in aluminum phosphide poisoning: The occurrence of injuries beyond the metabolic manifestations. J Res Med Sci 2017;22:94

How to cite this URL:
Mirakbari SM. The convergence of considerations in aluminum phosphide poisoning: The occurrence of injuries beyond the metabolic manifestations. J Res Med Sci [serial online] 2017 [cited 2019 Jul 22];22:94. Available from: http://www.jmsjournal.net/text.asp?2017/22/1/94/213060

Sir,

Aluminum phosphide (ALP) protects grains from pests, but toxicity to humans is still a major dilemma for society and health professionals, particularly in developing countries such as Iran and India. There is no antidote, and high mortality rate continues even with ongoing developments in treatment. Many papers which are published in the literature, review this important topic, providing extensive facts on metabolic manifestations as well as focusing on novel initiatives to scale-up the standard of care of patients. However, a vast majority of them have ignored recently published evidence that elaborates the causes of detrimental events associated with the metabolic disturbances. Thus, the story still continues why even with such advances in management protocols and lethal outcomes remain high.

There is evidence documenting harms beyond current standpoints in the field that may support the notion that the metabolic disturbances in themselves do not justify the fatal outcome of the toxicity.[1] These findings have resulted in elucidating new mechanisms of action of ALP and demonstrating ALP poisoning management modifications.[2]

It has been shown that thermal injuries contribute to high mortality rate in ALP poisoning cases.[1],[2] These findings have appeared in literature and have been employed in practice.[3],[4],[5] Yet, subsequent literature reviews and subordinate deductive reasoning indicate constant ignoring of these findings. [Table 1] has focused on the hierarchy of evidence breakdowns which result in the rationales behind the resettings in approach to ALP poisoning and conclude with certainty to converge the endeavors dealing with ALP strategies. It is suggested that the strategies of the approach to ALP poisoning both in research and practice should be comprehensive and inclusive, comprising both physical and metabolic complications of ALP poisoning; otherwise, our interventions would not achieve a favorable outcome.
Table 1: Published articles focusing on local thermal injuries in aluminum phosphide poisoning

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mirakbari SM. Hot charcoal vomitus in aluminum phosphide poisoning - A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature. Indian J Anaesth 2015;59:433-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Mirakbari SM. Proposal for a new mechanism of action for aluminum phosphide (ALP) for causing local injuries in ALP poisoning: Should treatment strategies be modified? Hum Exp Toxicol 2016;35:1145-6.  Back to cited text no. 2
[PUBMED]    
3.
Senthilkumaran S, Ananth C, Menezes RG, Thirumalaikolundusubramanian P. Aluminium phosphide poisoning: Need for revised treatment guidelines. Indian J Anaesth 2015;59:831-2.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Baruah U, Sahni A, Sachdeva HC. Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: Report of two cases. Indian J Crit Care Med 2015;19:735-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Masic I, Miokovic M, Muhamedagic B. Evidence based medicine - New approaches and challenges. Acta Inform Med 2008;16:219-25.  Back to cited text no. 5
[PUBMED]    



 
 
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