Journal of Medical Toxicology and Clinical Forensic Medicine

Keywords

ALP Tablet (Aluminum phosphide); Phosphine; Poisoning; Antidote; Antioxidants hydroquinone; Physician’s supervision

Introduction

The tablets may be available children and old folks caused an accidental poisoning and may have committed used for suicide attempts in teen and young people at home. Because if it is not applying the certainly appropriate therapeutic action for the poisoned patient they will even be died. So it looks like that using proper antidote this death and devastating factor in the body is removed and its operation is inhibited or neutralized. Unfortunately because the lack of suitable antidote and appropriate therapies poisoned person that comes to the hospital and just deaths several hours after their poisoning. Of course nowadays in the final stages of treatment in hospitals in order to prevent the patient's deaths blood replacement have also been reported in Tehran/Iran [1].

Methods

The ALP tablets immediately dissolved in stomach pH and absorbed in the gastrointestinal. So not only ¼ of tablet will dissolve and cause the person to be poisoned but also even with the release of 1/6 pills, death reports have been happened. Phosphorus available in brass tablets immediately after dissolving and becoming absorbed in the blood stream is converted to compound of PH3 or phosphine. Therefore the devastating and deadly cause of the toxicity compound is PH3 which place of function or its target is heart. And with the make of a dysrhythmia it causes the death of poisoned person. Of course nowadays in the final stages of treatment in hospitals in order to prevent the patient's deaths safety blood replacement have also been reported.

Results

Potassium permanganate is the first antidote used in the early stages of Aluminum phosphide tablets swallowing. This prevents from the tablet opening and dissolving. Medications and supportive treatment such delete of free radicals and toxins residues should be considered under the physician’s undervision. Despite of specialist physician trying in emergency of hospitals in a randomized annual mortality reports are available at poisoning treatment centers in Iran, especially in Sina Hospital of Tabriz/ Iran. Also annually at least some poisoned people with ALP tablets were death in Loghman hospital of Tehran/Iran.

Discussion

So it looks like that using proper antidote this death factor in the body is removed and its operation is inhibited or neutralized. Estimate the appropriate antidote as a view point insilico toxicology hypothesis with respect to molecular properties of PH3 structure with it’s including Electron pairs. Because phosphine has a link with drugs with specificity such low risk and strong electrophile properties [2-4]. Some of these antidotes are recommended with nontoxic doses such as combination of ortho- and para-hydroquinone, and carnosic acid or carnosol compounds that are found in the herb rosemary (Rosmarinus officinalis) and other drugs such Acetaminophen and phenobarbital [5-7] in the first stage of poisoning, it consider combination of usage drugs these drugs strongly connect to PH3 molecules. And although with regard to above mentioned medications as well as after dissolving and absorbing in the body they create dangerous free radicals too. So in the next step to increase the defensiveness activities to remove of free radicals application of hemoperfusion, hemofiltration, hemodialysis are recommended [8-10]. Then poisonous persons must use the appropriate antioxidant drugs with specify of low risk such vitamin E and vitamin C and curcumin and other medication such as digoxin in nontoxic doses to poisoning treatment proposal. Of course, other supportive therapy proceedings should also be applying under undervision of the specialist physicians [11-13].

Conclusion

Attention to incidence and mortality of aluminum phosphide poisoning in the around of the world it considers the finding of proper antidote is necessary. Because nowadays it is not found real antidote to this poisoning, so this study recommends that according to state of insilico toxicology methods giving hypothesize to designing antidotes to treatment of Aluminum phosphide poisoning is requirement to treatment.

Acknowledgment

We acknowledge that all Aluminum phosphide poisoning victims in this investigation. We have special thanks of from all clinics that work undervision of welfare organization in Tabriz/Iran. We are grateful from physicians and professors in Sina hospital at the medical sciences university of Tabriz/Iran.

References

1. Mehrpour O, Farzaneh E, Abdollahi M (2011) Successful Treatment of Aluminum Phosphide Poisoning with Digoxin: A Case Report and Review of Literature. Int J Pharmacol 7: 761-764.
2. Raies AB, Bajic VB (2016) In silico toxicology: computational methods for the prediction of chemical toxicity. Comput Mol Sci 6: 147-172.
3. Vedani A ,Smiesko M (2009) In silico toxicology in drug discovery - concepts based on three-dimensional models. Altern Lab Anim 37: 477-496.
4. Raunio H (2011) In silico toxicology – non-testing methods. Front Pharmacol 2: 33.
5. Nordlund JJ, Grimes PE, Ortonne JP (2006) The safety of hydroquinone. J Eur Acad Dermatol Venereol 20: 781-787.
6. Satoh T, McKercher SR, Lipton SA (2013) Nrf2/ARE-mediated antioxidant actions of pro-electrophilic  drugs. Free Radic Biol Med 65: 645-657.
7. Erkan N, Ayranci G, Ayranci E (2008) Antioxidant activities of rosemary (Rosmarinus Officinalis L.) extract, blackseed (Nigella sativa L.) essential oil, carnosic acid, rosmarinic acid and sesamol. Food Chem 110: 76-82.
8. Soltaninejad K, Nelson LS, Khodakarim N, Dadvar Z, Shadnia S (2011) Unusual complication of aluminum phosphide poisoning: Development of hemolysis and methemoglobinemia and its successful treatment. Indian J Crit Care Med 15: 117–119.
9. Hu S, Wang D, Jiang H, Lei Q, Zhu X, et al. (2013) Therapeutic Effectiveness of Sustained Low‐Efficiency Hemodialysis Plus Hemoperfusion and Continuous Hemofiltration Plus Hemoperfusion for Acute Severe Organophosphate Poisoning. Artif Organs 38: 121-124.
10. Friedrich JO, Wald R, Bagshaw SM, EA Burns K, KJ Adhikari N (2012) Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis. Crit Care 16:R146.
11. Schmidt HH, Stocker R, Vollbracht C, Paulsen G, Riley D, et al. (2015) Antioxidants in Translational Medicine. Antioxid Redox Signal 23: 1130-1143.
12. Aggarwal BB, Kumar A, Bharti AC (2003) Anticancer Potential of Curcumin: Preclinical and Clinical Studies. Anticancer Res 23: 363-398.
13. Maheshwari RK, Singh AK, Gaddipati J, Srimal RC (2005) Multiple biological activities of curcumin: A short review. Life Sci 78: 2081-2087.