Trend of blood lactate level in acute aluminum phosphide poisoning

doi:10.5847/wjem.j.1920-8642.2017.02.006

Abstract

Abstract:

BACKGROUND: Aluminum phosphide (AlP) poisoning is common in the developing countries. There is no specific antidote for the treatment of acute AlP poisoning. Early diagnosis of poisoning and outcome predictors may facilitate treatment decisions. The objective of this study was to determine the trend of blood lactate level in acute AlP poisoning to evaluate its role as a prognostic factor.

METHODS: This was a prospective study on acute AlP intoxicated patients during one year. Demographic data, clinical and laboratory data on admission, and outcome were recorded in a self-made questionnaire. Blood lactate levels were analyzed every two hours for 24 hours.

RESULTS: Thirty-nine (27 male, 12 female) patients were included in the study. The mortality rate was 38.5%. The mean blood pressure, pulse rate, blood pH and serum bicarbonate level were significantly different between the survivors and non-survivors groups. Blood lactate level was significantly higher in the non-survivors group during 8 to 16 hours post ingestion.

CONCLUSION: Blood lactate level could be used as an index of severity of acute AlP poisoning.

Key words: Aluminum phosphide, Poisoning, Blood lactate, Prognostic factor

Peyman Erfantalab, Kambiz Soltaninejad, Shahin Shadnia, Nasim Zamani, Hossein Hassanian-Moghaddam, Arezou Mahdavinejad, Behrooz Hashemi Damaneh. Trend of blood lactate level in acute aluminum phosphide poisoning[J]. World Journal of Emergency Medicine, 2017, 8(2): 116-120.

Figures/Tables 7

Table 1

Figure 1.

Figure 2.

Table 2

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Table 3

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Parameters	All patients (n=39) (%) Mean±SD (range)	Survivors group (n=24) (%) Mean±SD (range)	Non-survivors group (n=15) (%) Mean±SD (range)	P value
Sex
Male	27	16	11	0.66
Female	12	8	4
Age (year)	31.0±11.3 (17-65)	30.5±11.7 (17-65)	31.8±11.1 (23-61)	0.83
Number of AlP tablets	1.2±0.3 (0.25-6)	1.2±0.3 (0.5-6)	1.1±0.3 (0.25-6)	0.35
The use of AP tablets with water
Positive	5 (12.8)	5 (20.8)	0	0.06
Negative	34 (87.2)	19 (79.2)	15 (100)	0.06
TBOPAH^* (hour)	3.0±1.5 (0.5-6)	3.5±1.6 (0.5-6)	2.2±0.9 (0.5-4)	0.006
Glasgow Coma Scale	12.5±2.8 (3-15)	13.1±2.4 (7-15)	11.6±3.3 (3-15)	0.08
Systolic blood pressure (≤120 mmHg)	96.4±23.3 (50-152)	104.7±21.9 (60-152)	83.1±19.3 (50-120)	0.006
Diastolic blood pressure (≤80 mmHg)	59.9±16.1 (30-106)	64.6±17.0 (30-106)	52.3±11.4 (30-70)	0.008
Pulse rate (60-100 beats/minute)	96.1±22.8 (49-144)	104.5±20.9 (61-144)	82.7±19.4 (49-117)	0.003
Electrocardiogram
Normal	24 (61.5)	17 (70.8)	7 (46.7)	0.13
Abnormal	15 (38.5)	7 (29.2)	8 (53.3)	0.13
Blood pH (7.35-7.45)	7.26±0.14 (6.95-7.61)	7.30±0.13 (7-7.61)	7.20±0.13 (6.95-7.47)	0.02
PCO₂ (35-45 mmHg)	38.67±11.93 (11.5-68.6)	38.41±11.71 (11.5-68.6)	39.08±12.69 (15.9-57.2)	0.87
Serum HCO₃ (22-26 mEq/L)	17.51±5.82 (4.4-29.4)	19.04±6.13 (4.4-29.4)	15.05±4.45 (7.2-22.3)	0.03
Blood glucose (70-110 mg/dL)	143.4±83.6 (25-418)	134.7±66.3 (60-379)	157.5±106.8 (25-418)	0.44
Blood urea nitrogen (7-18 mg/dL)	28.6±8.7 (16-49)	27.0±8.4 (16-48)	31.1±8.8 (18-49)	0.10
White blood cell count [(7-10)×1 000/μL]	11.677±3.9 (4.5-22.7)	11.846±4.4 (4.5-22.7)	11.407±3.1 (7.2-20)	0.69
Hematocrit (35%-45%)	44.1±5.3 (26.6-54.3)	43.9±4.3 (36.9-54.3)	44.4±6.7 (26.6-52.2)	0.79

Time (hours)	Survivors group (n=24) Mean±SD	Non-survivors group (n=15) Mean±SD	P value
2	9.9±2.6	8.8±4.3	0.54
4	6.9±3.7	9.5±4.7	0.08
6	6.0±3.7	8.4±3.6	0.09
8	6.2±3.4	10.2±4.1	0.007
10	5.5±3.1	10.1±5.4	0.004
12	5.4±3.0	10.0±6.1	0.008
14	4.6±2.4	10.1±5.6	0.001
16	4.3±2.6	8.6±5.6	0.008
18	4.1±2.6	5.3±4.1	0.39
20	3.7±2.8	4.8±4.7	0.92
22	2.7±1.8	4.8±4.2	0.43
24	2.7±1.7	5.1±3.8	0.40

Time (hours)	Blood lactate level (mmol/L)	Area under the ROC curve	Sensitivity	Specificity	Relative risk (95% confidence interval)	P value
4	5.4	0.648	0.93	0.44	1.172 (0.974-1.411)	0.09
6	5.7	0.686	0.90	0.48	1.194 (0.963-1.479)	0.11
8	5.6	0.781	0.90	0.52	1.355 (1.051-1.749)	0.01
10	5.1	0.671	0.86	0.43	1.345 (1.058-1.709)	0.01
12	2.5	0.693	0.86	0.22	1.307 (1.034-1.652)	0.02
14	2.2	0.795	1.00	0.30	1.494 (1.081-2.066)	0.01
16	2.4	0.733	0.86	0.30	1.361 (1.034-1.791)	0.02
18	2.3	0.586	0.80	0.32	1.160 (0.828-1.625)	0.38
20	1.1	0.509	0.80	0.09	1.115 (0.834-1.492)	0.46
22	1.4	0.614	0.80	0.27	1.355 (0.925-1.984)	0.12
24	2.8	0.700	0.75	0.65	1.520 (0.934-2.474)	0.09

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