Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
Abstract
Alphos or poisioning (Celphos), a solid fumigant pesticide is widely used as a grain preservative grain preservative. It is one of the dreaded poisons, although found all over the world but more common in developing countries like India. Several ECG changes ranging from ST segment elevation/depression, PR and QRS interval prolongation, complete heart block to ectopics and fibrillation have been observed. Reversible myocardial injury has also been reported. Controversy exists regarding the various ECG changes seen in association with aluminum phosphide poisoning. Some authors have indicated in their studies that ECG abnormalities were poor prognostic markers other have observed that presence of ECG abnormalities did not predict mortality. Persistence of ECG changes after symptomatic recovery is a dilemma for the attending physician. There is paucity of literature and no specific guidelines are available for their management. A clinical profile of 45 patients, who got admitted in Intensive Care Unit (ICU) of sree Mookambika institute with alleged intake of celphos pellets, was studied. In all the 45 patients with alleged celphos poisoning, extensive gastric lavage was done with a mixture of coconut oil, KMNO4 and sodium bicarbonate solution. And patients were given symptomatic treatments along with supportive hemodynamic care with help of invasive and non‐invasive monitoring. ECG changes and other blood parameters were recorded and studied at admission and during the course of hospital admission. Out of 45 patients, 23 patients (51.11%) succumbed and 22 patients (48.89%) were successfully discharged, reflecting the graveness of this poisoning. Cardiotoxicity represents the primary cause of death in acute alumimium phosphide poisioning. ECG monitoring was done for all the patients. Most common physiological ECG manifestation was sinus tachycardia and most common pathological ECG manifestation was atrial fibrillation. On 1st day of admission, mortality rate for normal sinus rhythm was 16.67%, for patients with sinus tachycardia it was 33.3% and sinus bradycardia it was 25%. Among rhythm disturbances viz. Supra ventricular tachycardia, ventricular tachycardia and atrial fibrillation and ST‐T changes 100% mortality was seen. On day 3rd of admission among patients with sinus rhythm 12.50% patients died, With sinus bradycardia none died while with sinus tachycardia there was 50% mortality. Again 100% mortality was observed in patients with atrial fibrillation but 83.33% patient with ventricular tachycardia. 100% mortality was observed with T wave inversion on day 3. On day 5th,T wave inversion was found most commonly (13.33%) besides sinus bradycardia (20%) followed by ventricular tachycardia and supra ventricular tachycardia. No mortality was observed in patients having T wave changes but 100% mortality in patients with supra ventricular tachycardia and ventricular tachycardia. Majority of our study population consist of younger male adults. Most of the patients consumed 1 tablet of Aluminium phosphide and significant correlation between amount of celphos ingested and mortality was found. Out of 45 patients, 23 patients (51.11%) succumbed and 22 patients (48.89%) were successfully discharged, reflecting the graveness of this poisoning. Hypotension, low SPO2 at the time of admission is associated with bad prognosis and high case fatality. Biochemically high CPK‐MB, high creatinine, high SGPT is associated with grave prognosis. Patients who had persistent ECG changes from day 1 to day 5 and beyond have grave prognosis than those whose ECG changes only appeared later on in the course of their admission. Development of persistent tachy arrythmia since day 1 is poor prognostic sign. The ECG changes appearing late after 5 days may be non‐fatal. Death in first 24 hours appears to be cardiogenic as evidenced by shock and fatal arrhythmia.
How to cite this article:
K. Befin and K.A. Sharath Chandra. Study of ECG Manifestations in Patients of Aluminum Phosphide Poisoning.
DOI: https://doi.org/10.36478/makrjms.2025.3.134.140
URL: https://www.makhillpublications.co/view-article/1815-9346/makrjms.2025.3.134.140