Enter your email address
Submit
Write your message
Volume 18, Issue 2 (May 2024)
IJT 2024, 18(2): 113-119 |
Back to browse issues page
Ethics code: IR.MUI.MED.REC.1399.699
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Samsaam Shariat S, Gheshlaghi F, Zoofaghari S. Effectiveness of Plasmapheresis in the Treatment and Clinical Outcome of Patients with Aluminum Phosphide Poisoning: A Randomized Controlled Clinical Trial. IJT 2024; 18 (2) :113-119
URL: http://ijt.arakmu.ac.ir/article-1-1296-en.html
URL: http://ijt.arakmu.ac.ir/article-1-1296-en.html
1- Department of Clinical Toxicology, Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran ,Shafeajafar@med.mui.ac.ir
2- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran ,
Abstract: (233 Views)
Background: Nowadays, therapeutic plasma exchange (TPE) is considered a novel and promising treatment in cases of poisoning. However, few studies have been conducted on the use of TPE as a treatment in various toxicity cases, especially aluminum phosphide (AlP) poisoning. Therefore, the present study aimed to investigate the efficacy of plasmapheresis in the treatment and clinical outcome of patients with AlP poisoning.
Methods: We conducted this randomized controlled clinical trial on 80 patients poisoned with AlP. The control patients (n=58) received only the routine treatment, whereas those in the experimental group (n=22) underwent plasmapheresis in addition to the routine treatment. The plasmapheresis was given to these patients immediately after they had received the routine treatment, within the first six hours of their hospital admission.
Results: The study results revealed that the mean hematocrit level in the plasmapheresis group (34.31±3.31%) was significantly lower than that of patients in the control group (38.05±4.80%) 12 h after the plasmapheresis treatment (P=0.046). Moreover, there were six (27.3%) and 14 (24.1%) cases of mortality in the plasmapheresis group and the control group, respectively. There was no significant difference in the mortality rates between the two groups (P=0.778).
Conclusion: Based on the results of this study, plasmapheresis had a significant effect on increasing the blood HCO3 level within 12 h after the intervention. Therefore, it had a significant role in reducing the resultant acidosis in patients with AlP poisoning; however, this effect did not reduce the mortality rate after plasmapheresis.
Methods: We conducted this randomized controlled clinical trial on 80 patients poisoned with AlP. The control patients (n=58) received only the routine treatment, whereas those in the experimental group (n=22) underwent plasmapheresis in addition to the routine treatment. The plasmapheresis was given to these patients immediately after they had received the routine treatment, within the first six hours of their hospital admission.
Results: The study results revealed that the mean hematocrit level in the plasmapheresis group (34.31±3.31%) was significantly lower than that of patients in the control group (38.05±4.80%) 12 h after the plasmapheresis treatment (P=0.046). Moreover, there were six (27.3%) and 14 (24.1%) cases of mortality in the plasmapheresis group and the control group, respectively. There was no significant difference in the mortality rates between the two groups (P=0.778).
Conclusion: Based on the results of this study, plasmapheresis had a significant effect on increasing the blood HCO3 level within 12 h after the intervention. Therefore, it had a significant role in reducing the resultant acidosis in patients with AlP poisoning; however, this effect did not reduce the mortality rate after plasmapheresis.
References
1. Eddleston M, Karalliedde L, Buckley N, Fernando R, Hutchinson G, Isbister G, et al. Pesticide poisoning in the developing world - a minimum pesticides list. Lancet.2002;360:1163-67. [doi:10.1016/S0140-6736(02)11204-9]
2. Eddleston M. Poisoning by pesticides. Medicine. 2020;48(3):214-17. [doi:10.1016/j.mpmed.2019.12.019]
3. Bagherian F, Kalani N, Rahmanian F, Abiri S, Hatami N, Foroughian M, et al. Aluminum phosphide poisoning mortality rate in Iran; A systematic review and meta-analysis. Arch Acad Emerg Med. 2021;9(1): 29-36. [doi: 10.22037/aaem.v9i1.1396] [pmid: 34870232]
4. Dorooshi G, Mirzae M, Fard NT, Zoofaghari S, Mood NE. Investigating the outcomes of aluminum phosphide poisoning in khorshid referral hospital, Isfahan, Iran: A retrospective study. Journal of Research in Pharmacy Practice. 2021;10(4):166. [doi:10.4103/jrpp.jrpp_88_21]
5. Garg KK. Review of aluminum phosphide poisoning. International Journal of Medical Science and Public Health. 2020;9(7):392-400. [doi:10.5455/ijmsph.2020.07118202020072020]
6. Singh S, Singh D, Wig N, Jit I, Sharma BK. Aluminum phosphide ingestion - a clinico-pathologic study. Journal of Toxicology: Clinical Toxicology. 1996;34(6):703-06. [doi:10.3109/15563659609013832]
7. Mathai A, Bhanu MS. Acute aluminium phosphide poisoning: Can we predict mortality?.Indian Journal of Anaesthesia. 2010; 54 (4): 302-07. [doi:10.4103/0019-5049.68372]
8. Hashemi-Domeneh B, Zamani N, Hassanian-Moghaddam H, Rahimi M, Shadnia S, Erfantalab P, et al. A review of aluminium phosphide poisoning and a flowchart to treat it. 2016;67:183-93. [Arhiv Za Higijenu Rada I Toksikologiju.]
9. Araújo RV, Santos SD, Igne Ferreira E, Giarolla J. New advances in general biomedical applications of PAMAM dendrimers. Molecules. 2018;23(11):2849. [doi:10.1515/aiht-2016-67-2784]
10. Gheshlaghi F, Lavasanijou MR, Moghaddam NA, Khazaei M, Behjati M, Farajzadegan Z, et al. N‑acetylcysteine, ascorbic acid, and methylene blue for the treatment of aluminium phosphide poisoning: Still beneficial? Toxicol Int. 2015; 22:40‑4. [doi:10.4103/0971-6580.172255]
11. Dorooshi G, Zoofaghari S, Mood NE, Gheshlaghi F. A newly proposed management protocol for acute aluminum phosphide poisoning. Journal of Research in Pharmacy Practice. 2018; 7:168‑69. [doi:10.4103/jrpp.JRPP_18_12]
12. Moghadamnia AA. An update on toxicology of aluminum phosphide. DARU J Pharm Sci . 2012;20:1-8. [doi:10.1186/2008-2231-20-25]
13. Ari HF, Turhan M, Baspinar H, Kirhan B, Ari M. Aluminum phosphide toxicity: A rare cause of multiorgan dysfunction syndrome. Indian Pediatrics Case Reports. 2022;2(2):91. [doi:10.4103/ipcares.ipcares_3_22]
14. Shariat SS, Zoofaghari S, Gheshlaghi F. Effectiveness of plasmapheresis in aluminum phosphate poisoning. Journal of Research in Pharmacy Practice. 2021;10(1):57. [doi:10.4103/jrpp.JRPP_21_27]
15. Ibrahim RB, Balogun RA. Medications in patients treated with therapeutic plasma exchange: prescription dosage, timing, and drug overdose. Seminars Dialysis. 2012;25:176e189. [doi:10.1111/j.1525-139X.2011.01030.x]
16. Samtleben W, Mistry‐Burchardi N, Hartmann B, Lennertz A, Bosch T. Therapeutic plasma exchange in the intensive care setting. Ther Apher. 2001;5(5):351-57. [doi:10.1046/j.1526-0968.2001.00383.x]
17. Yazdi MF, Baghianimoghadam M, Nazmiyeh H, Ahmadabadi AD, Adabi MA. Response to plasmapheresis in myasthenia gravis patients: 22 cases report. Romanian journal of internal medicine. 2012;50(3):245-47. [Link]
18. Yokoyama S, Kikkawa T, Hayashi R. Plasmapheresis: new trends in therapeutic applications. Therapy of hypercholesterolemia. In Proc 2nd International Symposium on Plasmapheresis: Artificial Organs. Supplement. 1984. [Link]
19. Ahila Ayyavoo DN, Muthialu N, Ramachandran P. Plasmapheresis in organophosphorus poisoning-intensive management and its successful use. J Clin Toxicol.2011;1:2161-95. [Link]
20. Disel NR, Acikalin A, Kekec Z, Sebe A. Utilization of plasmapheresis for organophosphate intoxication: A case report. Turkish Journal of Emergency Medicine. 2016;16(2):69-71. [doi:10.1016/j.tjem.2015.06.003]
21. Güven M, Sungur M, Eser B. The effect of plasmapheresis on plasma cholinesterase levels in a patient with organophosphate poisoning. Human & Experimental Toxicology. 2004;23(7):365-68. [doi:10.1191/0960327104ht462cr]
22. Nenov VD, Marinov P, Sabeva J, Nenov DS. Current applications of plasmapheresis in clinical toxicology. Nephrology dialysis transplantation. 2003;18(suppl_5):v56-8. [doi:10.1093/ndt/gfg1049]
23. Deng Y, Qiu L. Therapeutic plasma exchange: a second‐line treatment for brodifacoum poisoning following an anaphylactoid reaction to vitamin K. Clin Case Rep. 2017;5(1):35. [doi:10.1002/ccr3.756] [pmid: 28096987]
24. Sari I, Turkcuer I, Erurker T, Serinken M, Seyit M, Keskin A. Therapeutic plasma exchange in amitriptyline intoxication: case report and review of the literature. Transfusion and Apheresis Science. 2011;45(2):183-85. [doi:10.1016/j.transci.2011.07.015]
25. Patel N, Bayliss GP. Developments in extracorporeal therapy for the poisoned patient. Advanced Drug Delivery Reviews. 2015; 90:3-11. [doi:10.1016/j.addr.2015.05.017]
26. Zamani N, Hassanian-Moghaddam H, Ebrahimi S. Whole blood exchange transfusion as a promising treatment of aluminium phosphide poisoning. Arhiv Za Higijenu Rada I Toksikologiju. 2018;69(3):275-7. [doi:10.2478/aiht-2018-69-3129]
27. Kartal O, Gulec M, Caliskaner Z, Nevruz O, Cetin T, Sener O. Urticaria Case Reports: 587 Plasmapheresis in a Patient with "Refractory" Urticarial Vasculitis. World Allergy Organ J. 2012;5(Suppl 2):S203. [doi:10.1097/01.WOX.0000411702.50677.f2]
28. Basic‐Jukic N, Kes P, Glavas‐Boras S, Brunetta B, Bubic‐Filipi L, Puretic Z. Complications of therapeutic plasma exchange: experience with 4857 treatments. Therapeutic Apheresis and Dialysis. 2005;9(5):391-95. [doi:10.1111/j.1744-9987.2005.00319.x]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
The Iranian Journal of Toxicology
Arak University of Medical Sciences in collaboration with the Iranian Society of Toxicology
Website: http://ijt.arakmu.ac.ir
Email: tox.journal@gmail.com
