Frequency of Macroscopic and Microscopic Findings from Autopsy in the Deceased Caused by Poisoning with Aluminum Phosphide, Zinc Phosphide and Super Warfarin Rodenticides

Document Type : Original Article(s)

Authors

1 Assistant Professor, Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences , Isfahan, Iran

4 Forensic Medicine Specialist, Legal Medicine Research Center, Isfahan, Iran

5 Professor, Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Poisoning with super-warfarin, zinc phosphide (ZnP) and aluminum phosphide (ALP) are among the most prevalent types of rodenticide poisonings. The purpose of this study was to investigate the frequency of macroscopic and microscopic findings obtained from autopsy in the deceased due to poisoning with these rodenticide poisons.
Methods: This cross-sectional study was conducted in 2020 at the Isfahan Forensic Medical Center and the referral poisoning emergency center at Khorshid Hospital, Isfahan, Iran. Autopsy and pathological findings in  deceased cases due to phosphides and super warfarin poisoning were evaluated from March 21, 2018 to February 20, 2021.
Findings: During the study period, 165 patients were hospitalized due to super warfarin and ZnP; and 105 patients with ALP poisoning. No deaths were reported from super-warfarin. One patient died from ZnP poisoning who did not undergo autopsy. 37(35.2%) individuals died from ALP of which 33 cases underwent postmortem examination. 24(72.7%) of the deceased were men. And the average age was 29.39 years. In the autopsy findings, pulmonary edema (69.6%) and pleural effusion (21.2%) were the most common findings in ALP poisoning. The pathological findings were liver degeneration, pulmonary edema, and pulmonary hemorrhage. There was a significant relationship between serum bicarbonate levels at admission and liver autopsy findings. The time from ingestion to hospital admission also correlated with liver pathology findings.
Conclusion: Considering the prevalence of pulmonary edema and pleural effusion in deceased patients with ALP poisoning, fluid therapy guidance through central venous pressure monitoring should be considered.

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References

  1. Isackson B, Irizarry L. Rodenticide toxicity. StatPearls [Internet]: StatPearls Publishing; 2021.
  2. Hosseinian A, Pakravan N, Rafiei A, Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran. Indian J Med Sci 2011; 65(4): 143-50.
  3. Bertero A, Chiari M, Vitale N, Zanoni M, Faggionato E, Biancardi A, et al. Types of pesticides involved in domestic and wild animal poisoning in Italy. Sci Total Environ 2020; 707: 136129.
  4. Watt BE, Proudfoot AT, Bradberry SM, Vale JA. Anticoagulant rodenticides. Toxicol Rev 2005; 24(4): 259-69.
  5. Stroope S, Walton R, Mochel JP, Yuan L, Enders B. Retrospective evaluation of clinical bleeding in dogs with anticoagulant rodenticide toxicity-A multi-center evaluation of 62 cases (2010-2020). Front Vet Sci 2022; 9: 879179.
  6. Nelson AT, Hartzell JD, More K, Durning SJ. Ingestion of superwarfarin leading to coagulopathy: a case report and review of the literature. MedGenMed 2006; 8(4): 41.
  7. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol (Phila) 2009; 47(2): 89-100.
  8. Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: a review of literature. Forensic Sci Int 2012; 214(1-3): 1-6.
  9. Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock 2011; 4(3): 378-84.
  10. Trakulsrichai S, Kosanyawat N, Atiksawedparit P, Sriapha C, Tongpoo A, Udomsubpayakul U, et al. Clinical characteristics of zinc phosphide poisoning in Thailand. Ther Clin Risk Manag 2017; 13: 335-40.
  11. Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: systematic review. BMC Public Health 2007; 7(1): 357.
  12. Etemadi-Aleagha A, Akhgari M, Sardari Iravani F. Aluminum phosphide poisoning-related deaths in Tehran, Iran, 2006 to 2013. Medicine (Baltimore) 2015; 94(38): e1637.
  13. Dorooshi G, Mirzae M, Tavakoli Fard N, Zoofaghari S, Eizadi Mood N. Investigating the outcomes of aluminum phosphide poisoning in Khorshid Referral Hospital, Isfahan, Iran: A retrospective study. J Res Pharm Pract 2021; 10(4): 166-73.
  14. Murali R, Bhalla A, Singh D, Singh S. Acute
    pesticide poisoning: 15 years experience of a large North-West Indian hospital. Clin Toxicol (Phila) 2009; 47(1): 35-8.
  15. Moghadamnia AA. An update on toxicology of aluminum phosphide. DARU 2012; 20(1): 25.
  16. Rahbar Taromsari M, Teymourpour P, Jahanbakhsh R. Survey the histopathological findings in autopsy of poisoned patients with rice tablet (Aluminium Phosphide) [in Persian]. J Guilan Univ Med Sci 2011; 19(76): 56-63.
  17. Shokrzadeh M, Alizadeh A, Veisi F, Nasri-Nasrabadi N. The mortality rate of aluminum phosphide poisoning; a comparison with other poisonings recorded in Mazandaran Department of Forensic Medicine, Iran, 2009-2011 [in Persian]. J Isfahan Med Sch 2015; 33(322): 114-24.
  18. Siddique AB, Yeasmin N, Rashid H, Rahman M, Arefin SS, Asraf MM. Clinical presentation and outcome of aluminium phosphide poisoning. Adv Med Dent Health Sci 2022; 5(3): 24-8.
  19. Sarkar MK, Ghosh N, Rakesh U, Prasad R, Raj R. Acute aluminium phosphide poisoning: A case report of rare survival with cardiac, metabolic, hepatic, and renal complications. J Family Med Prim Care 2022; 11(11): 7452-5.
  20. Yashaswini LS. Rare survival of a young lady with acute aluminium phosphide poisoning. Narayana Med J 2022; 10(2): 75-6.
  21. Kumar A, Prakash J, Arya G, Yadav AK, Dhankar A. Veno-arterial extracorporeal membrane oxygenation as a bridge to recovery in acute aluminium phosphide poisoning: A case report. Asian J Med Sci 2022; 13(2): 175-7.
  22. Masoumi G, Ganjei Z, Teymoori E, Sabzghabaee AM, Yaraghi A, Akabri M, et al. Evaluating the prevalence of intentional and unintentional poisoning in vulnerable patients admitted to a referral hospital [in Persian]. J Isfahan Med Sch 2013; 31(252):
    1452-60.
  23. Khodabandeh F, Kahani A, Soleimani G. The study of fatal complications of “rice tablet “poisoning [in Persian]. Iran J Forensic Med 2014; 20(2): 27-36.
  24. Mathai A, Bhanu MS. Acute aluminium phosphide poisoning: Can we predict mortality? Indian J Anaesth 2010; 54(4): 302-7.
  25. Navabi SM, Navabi J, Aghaei A, Shaahmadi Z, Heydari R. Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: characteristics and predictive factors. Epidemiol Health 2018; 40: e2018022.
Journal of Isfahan Medical School
Volume 41, Issue 718
2nd Week, July
July and August 2023
Pages 326-333

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History

  • Receive Date: 11 August 2022
  • Revise Date: 09 December 2022
  • Accept Date: 08 May 2023

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