The mixture was distilled. 53. This highly toxic substance is used for rice and other grains protection in Iran. National Library of Medicine 16. The 46. 2. Chugh SN. Chugh SN, Ram S, Chugh K, et al. Acute opiate overdose is one of the most dramatic complications of drug abuse in Iran.35 All of the suicidal cases in the present study showed positive results for at least 1 drug category. (2003) the pattern of poisoning varied in urban and rural areas, with a higher incidence of poisoning deaths in rural (64%) than in urban areas (36%). Effect of acute aluminum phosphide exposure on rats: a biochemical and histological correlation. Prevalence of fatalities due to Aluminium phosphide poisoning in Southern Rajasthan (an epidemiological study). The Authors. about navigating our updated article layout. Pure phosphine gas is odorless and colorless. AlP has currently aroused interest with a rising number of cases in the past four decades due to increased use for agricultural and non-agricultural purposes. 3. Karamjit S, Oberoi SS, Bhullar DS. Autopsy sheets were reviewed and cases with the history of aluminum phosphide poisoning were selected. Autopsy sheets were reviewed and cases with the history of AlP poisoning were selected consecutively to be investigated in the present study. Spot diagnosis of aluminium phosphide ingestion: an application of a simple test. Suicide was the most common mode of poisoning deaths, with overall mortality varying between 70100%. Saraswat PK, Gupta BP, Malhotra VK, Goyal VK. Occupational exposure to aluminium phosphide and phosphine gas? Except the largest producer of it in India, it has been marketed as granulated powder in 10 g plastic sachets. Intentional and accidental poisoning with phosphides isdangerous.13 In order to control and prevent acute deaths associated with the most toxic compounds, several countries use the legal regulation of pesticides trading and utilization.14 Authorities banned AlP containing tablets in Iran since 2007.15 Despite this regulation, continuing the use of this substance causes increase in the incidence of AlP poisoning and it is now one of the most common suicidal poisoning and cause of death in Iran. Poisoning trends in the Malwa region of Punjab. In many cases, more than 1 additional drug or substance were found in biological samples (Table 1). As it is shown in Table 1, morphine alone or in combination with other drugs was the most frequent drug detected in postmortem samples (180 cases, 8.97%), followed by ethanol (63 cases, 3.14%), amitriptyline (55 cases, 2.74), and other drugs and poisons. Review article. Phosphine analysis in postmortem specimens following ingestion of aluminium phosphide. Nikfar S, Kebriaeezadeh A, Majdzadeh R, et al. Ten control blood samples from various autopsies showed Al values between 9 and 15 g/L using emission spectrometry, whereas blood in the deceased contained 100 times more. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Current trend of poisoning in Jamnagar. This is a case of suicidal consumption of aluminium phosphide by a 32-year-old young medical anesthetist who was under training at a reputed hospital. The other reason for getting negative results is that there are other causes of death other than phosphine poisoning. and 100% in Jain et al. In urine and the kidneys, no difference from the usual published values was found, probably because death occurred shortly after ingestion. The manner of death was reported to be suicidal in 87% of the cases by Dalbir et al. Arora B, Punia RS, Kalra R, et al. Classes of drugs and their prevalence in multiple drug intoxication in suicides and accidents. 39. The coroners autopsy reports can make valuable information about the use of toxic substances for different purposes. Cecil 9000 spectrophotometer was used to detect carboxyhemoglobine in blood samples. Deaths due to other causes were excluded. 52. Morphine, ethanol, and amitriptyline were the most common additional drugs detected in toxicological analysis. Research Article: Observational Study (STROBE Compliant), Additional Drugs and Substances Detected With Phosphine Gas in Biological Samples of Referred Cases to Toxicology Department, Tehran, Iran, 2006 to 2013, Case History Distribution of Aluminum Phosphide Poisoning-Related Deaths, Tehran, Iran, 2006 to 2013. Singh S, Singh D, Wig N, et al. Phosphide poisoning: a review of literature. The incidence of referred cases and positive phosphine test cases showed an increasing trend (P < 0.05) from 2006 to 2013 per 1 million of Tehran population (Figure 3). 1985). There was no significant difference between the number of males and females (P > 0.05). Metal phosphides such as aluminum phosphide are potent insecticides. Misra UK, Bhargava SK, Nag D, et al. Age range distribution of fatal phosphine poisoning cases referred for phosphine analysis in Tehran, Iran in an 8-year study, Tehran, Iran, 2006 to 2013. 27. Pesticide poisoning trend analysis of 13 years: a retrospective study based on telephone calls at the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Carson HJ. The incidence of the poisoning has been increasing steadily and is now the commonest mode of suicide in the agricultural community in northern India (Ranga et.al, 2004). Kapoor AK, Sinha US, Singh AK, et al. aluminium phosphide, phosphine, poisoning, suicide. 9. 32. http://creativecommons.org/licenses/by-nc-nd/4.0. It is available in small and large packs containing grayish-white tablets weighing about 3 g each, containing 56% aluminium phosphide and 44% aluminium carbonate, capable of releasing 1 g of phosphine. All data were analyzed using Chi-squared test SPSS18 for the testing of significance in the trends of total referred cases for phosphine analysis, total number of positive phosphine tests in Tehran population, age range distribution, incidence of referred cases for phosphine analysis, and positive phosphine tests in Tehran per 1 million of population from 2007 to 2013. According to the Legal Medicine Research Center Ethics Committee law, all personal information needed to perform any research studies on postmortem cases should be confidential. The distillate was collected in an ice cold receiver. There are case reports of accidental inhalation of phosphine in these clandestinelaboratories.41,42 Another way for accidental phosphine poisoning was reported among workers engaged in fuming of stored grains.43,44 We do not have any report or history of accidental poisoning in the present study, but we suppose that poisoning in lower age ranges (010 years) can be accidental. Accidental and intentional exposure to AlP fumigants had been described by previous studies. We should say that we encountered some limitations in the present study. HS-GC/NPD technique is used as a confirmatory method for silver nitrate and ammonium molybdate tests in the present study. Biological samples were analyzed for the detection of heavy metals with Reinsch test. may email you for journal alerts and information, but is committed Vendors and shop keepers should not sell the tablets to young people and children without proper verification and confirmation. Overall mortality in cases of aluminium phosphide poisoning varies between 70100%. Bogle RG, Theron P, Brooks P, et al. government site. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, September 2015 - Volume 94 - Issue 38 - p e1637, http://en.wikipedia.org/wiki/Reinsch_test, http://www.fao.org/docrep/x5042e/x5042e0a.htm, http://www.inchem.org/documents/icsc/icsc/eics0694.htm, Aluminum Phosphide Poisoning-Related Deaths in Tehran, Iran, 2006 to 2013, Articles in PubMed by Afshar Etemadi-Aleagha, MD, Articles in Google Scholar by Afshar Etemadi-Aleagha, MD, Other articles in this journal by Afshar Etemadi-Aleagha, MD. In Tech; 2011: 251278. Actue aluminium phosphide poisoning. A forensic view of pesticide poisonings in Brazil. This highly toxic chemical is cheap and usually formulated in tablets or pellets, granules and as powder. 55. 35. In India it is marketed as a tablet of celphos, alphos, quick phos, phostoxin, etc. Systemic involvement in Aluminium phosphide poisoning. In France, aluminium phosphide is used for crop protection and because of its toxicity to humans and domestic animals, the use of AlP is strictly controlled and it cannot be freely supplied. Information needed in the present study was based on previous autopsy and analytical toxicology reports, thus no ethical approval and patient consent are required. Fatal aluminum phosphide poisoning in TehranIran from 2007 to 2010. Occupational exposure to aluminium phosphide and phosphine gas? Phosphine was detected in 51.82% of cases. The site is secure. Trend of the total referred cases for phosphine analysis, total number of positive phosphine tests in Tehran population in an 8-year study, Tehran, Iran, 2006 to 2013. The manner of death was suicidal attempt in 85% of the study cases. Etemadi-Aleagha, Afshar MD; Akhgari, Maryam Pharm D, PhD; Iravani, Fariba Sardari MD, From the Tehran University of Medical Sciences (TUMS), Amir Alam Hospital, Tehran, Iran (AE-A) and Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran (MA, FSI). Wolters Kluwer Health Aluminium phosphide (AlP) is a cheap solid fumigant and a highly toxic pesticide which is commonly used for grain preservation. The authors wish to thank the kind personnel of the Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran for their co-operation in this study. In this study, there was a significant increase (P < 0.05) in the numbers of deaths due to phosphine poisoning in an 8-year study (Figure 1). The present study was conducted to show the increasing incidence of fatal aluminum phosphide poisoning and its toxicological and forensic aspects in an 8-year study, 2006 to 2013. This substance has no effective antidote and the incidence of deaths due to its poisoning is increasing day by day in Iran. A headspace sampler combined with an Agilent GC7890A-NPD equipped with a HP-1 GC column (30 m length 0.32 mm I.D. People handling this fumigant must be aware of its lethal aspects. Peshin SS, Srivastava A, Halder N, et al. Toxicological analyses detected aluminium phosphide. 4. Chopra JS, Kalra OP, Malik VS, Sharma R, Chandna A. Aluminium phosphide poisoning: a prospective study of 16 cases in one year. Khosla SN, Handa R, Khosla P. Aluminium phosphide poisoning. Jain AK, Nigam M, Garg SD, et al. Liquidliquid extraction was used to prepare biological samples (urine, blood, liver, bile, and stomach content) before toxicological analysis. The work cannot be changed in any way or used commercially. During opening of these sachets for oral ingestion, AlP gets exposed to atmosphere moisture and phosphine gas escapes from the formulation thus its concentration decreases.50,51 According to the study of Murali et al47 change in the formulation of AlP from 3-g tablets to 10-g granulated powder in plastic sachets has led to a decline in the mortality rate of phosphide poisoning in India. The profile of acute poisonings in Haryana: Rohtak study. Manual of fumigation for insect control. Its easy availability in the markets has increased also its misuse for committing suicide. Age range distribution of fatal phosphine poisoning cases referred for phosphine analysis was studied. In: Stoytcheva, M. It is higher in those who consume more than two tablets and none of the patients who had ingested more than 3 tablets survived (Siwach et al., 1988, Singh et al., 1985, Raman et al. The purpose of the present study was to investigate phosphine poisoning-related deaths in Tehran, Iran in an 8-year interval. 28. 11. Idali B, Miguil M, Moutawakkil S, et al. Aluminium phosphide is marketed in India as tablets of Celphos, Quickphos, etc. On post-mortem examination, cyanosis was present over the nail bed. Please enable scripts and reload this page. Shields LBE, Hunsaker DM, Hunsaker Iii JC, et al. Kabra SG, Narayanan R. Aluminium phosphide: worse than Bhopal. Despite Asian countries, AlP is only available for qualified users in European countries such as UK, thus suicide by AlP ingestion is rare.21. Hosseinian A, Pakravan N, Rafiei A, et al. Arora B, Punia RS, Kalra R, Chugh SN, Arora DR. Histopathological changes in aluminium phosphide poisoning. reported in 1993 an accidental death related to phosphine exposure from stored grain fumigated with AlP pellets. Mishra UK, Tripathi AK, Pandey R. The spectrum of phosphine toxicity in India. Investigation of a fatality from non occupational aluminium phosphide exposure: measurement of aluminium in tissue and body fluids as a marker of exposure. Correspondence: Maryam Akhgari, Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Old Ghom Road, 500 Meters After Beheste Zahra, 1816153141 Tehran, Iran (email: [emailprotected]). This is a case of suicidal consumption of aluminium phosphide by a 32-year-old young medical anesthetist. This increase shows that governmental restrictions for selling AlP tablets had not been effective so far and these tablets are cheap and easy available in Iran. 51. Singh SP, Aggarwal AD, Oberoi SS, et al. The .gov means its official. Your message has been successfully sent to your colleague. 30. Shadnia S, Mehrpour O, Abdollahi M. Unintentional poisoning by phosphine released from aluminum phosphide. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Garry et al. The results of this study showed that in spite of ban and restrictions, there was a dramatic increase in the incidence of fatal aluminum phosphide poisoning in Tehran from 2006 to 2013. Proudfoot AT. Phosphine generated in the gastrointestinal tract is readily absorbed into the blood stream. The mean age (standard deviation) of cases was 26.82 (10.58) years with the age range of 5 to 74 years. Musshoff F, Preuss J, Lignitz E, et al. Also Bogle48 reported 93 cases of AlP poisoning in a 4-year study. 13. ), Pesticides in the Modern World: Effects of Pesticides Exposure. 29. It inhibits mitochondrial oxidative phosphorylation by blocking cytochrome c oxidase, inhibits cellular respiration, and results in multi-organ damage and death.9 There is no specific antidote for phosphine gas poisoning and many patients do not survive despite intensive care.10,11 AlP tablets, known as rice tablets, are used to protect rice during long-term stock storage in Iran.