Classes of drugs and their prevalence in multiple drug intoxication in suicides and accidents. The mortality rate in clinical reports is stated to vary between 37100% by different authors (Chopra et al., 1986; Kabra et al., 1988; Sepaha et al., 1985; Saraswat et al., 1985; Ram et al., 1985; Khosla et al., 1986; Mishra et al., 1989; Chugh et al., 1991, 1992, 1995). 24. 7. Mehrpour O, Singh S. Rice tablet poisoning: a major concern in Iranian population. Heart and lungs are target organs for phosphine gas.54 In experimental studies, phosphine can induce oxidative damage in liver, lungs, and brain of rats.2 Histopathological examination of vital organs showed congestion, edema, and leukocyte infiltration especially in lungs, kidneys, and adrenal, which suggest cellular hypoxia in the study of Arora et al.49 Anand et al55 findings confirm the presence of congestion in liver and lungs of rats exposed to AlP. On toxicological analysis, aluminium phosphide was detected. Toxicological analysis results, demographic and necroscopic examination findings were studied. Data is temporarily unavailable. 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. The lungs were congested and edematous with rupture of alveoli, gastrointestinal mucosal congestion (Figure 1), and petechial hemorrhages on the surface of the liver and brain. Included in the present study were 385 (9.18%) cases with positive results for drugs and poisons other than phosphine. Phosphine was detected in tissues of the brain, liver, and kidneys. Some vital organs were found to be congested in the present study; this finding had also been observed in the previous studies.2,46,52,53 Many studies pointed out to the organ toxicity of AlP poisoning. Phosphide poisoning: a review of literature. Phosphine is a volatile substance; it can be evaporated from body during the period of death to autopsy, also in decontamination processes in hospital the concentration of phosphine declines in the body. 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]). Federal government websites often end in .gov or .mil. P values of 0.05 were considered indicative of statistically significant difference. Effect of acute aluminum phosphide exposure on rats: a biochemical and histological correlation. Saraswat PK, Gupta BP, Malhotra VK, Goyal VK. 19. In urine and the kidneys, no difference from the usual published values was found, probably because death occurred shortly after ingestion. Shields LBE, Hunsaker DM, Hunsaker Iii JC, et al. Due to its high toxicity potential and easy availability, it is widely used as a suicide poison. A total of 51.8% of studied cases were female. Severity factors of aluminium phosphide poisoning (Phostoxin). 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). Bumbrah GS, Krishan K, Kanchan T, et al. Chopra JS, Kalra OP, Malik VS, Sharma R, Chandna A. Aluminium phosphide poisoning: a prospective study of 16 cases in one year. Sinha US, Kapoor AK, Singh AK, et al. The Singh D, Jit I, Tyagi S. Changing trends in acute poisoning in Chandigarh zone: a 25-year autopsy experience from a tertiary care hospital in northern India. A gas chromatographic analysis of phosphine in biological material in a case of suicide. Detailed and accurate history regarding the time and quantity of AlP tablets ingested, concomitant use of other drugs and resuscitative measures, decedents hospitalization and survival time were not included in the death certificate of cases. Received 2014 Oct 4; Revised 2015 Jan 10; Accepted 2015 Jan 14. The sample was mixed with the same amount of water and acidified with dilute sulfuric acid. Histopathological changes in aluminium phosphide poisoning. Legislative and administrative measures have been suggested to restrict and modify its supply in India. Table 1 shows the most common detected drugs and substances in postmortem samples of these cases. Musshoff F, Preuss J, Lignitz E, et al. Reinsch test is an initial, simple, and qualitative method for the detection of heavy metals (eg, mercury, bismuth, arsenic, antimony, thallium) in biological and nonbiological samples (body fluids, homogenized tissue, food, and drink). 14. Proudfoot AT. 36. Age, sex, toxicological analysis results, and necroscopic signals were variables of interest. Upon contact with moisture, aluminium phosphide liberates phosphine, which is the active pesticidal component (Sudakin, 2005). In agreement with our findings Murali et al stated that males did not outnumbered females, while male/female ratio was 2/1 in the study of Kapoor et al.22,47 Maximum deaths belonged to the young age groups. Metal phosphides such as aluminum phosphide are potent insecticides. 27. Chefurka W, Kashi KP, Bond EJ. (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%). Mathai A, Bhanu MS. Shadnia S, Rahimi M, Pajoumand A. Published by Wolters Kluwer Health, Inc. 33. Chugh SN. In Iran it is known as the rice tablet (Mehrpour et al., 2010) that can be purchased in local shops. There was no significant difference between the number of males and females (P > 0.05). Positive results were obtained for phosphine using this method too. may email you for journal alerts and information, but is committed FOIA Mucosa of the stomach congested and hemorrhagic. Please enable scripts and reload this page. Moffat AC, Osselton MD, Widdop B. Moffat AC, Osselton MD, Widdop B. Forensic toxicology. Manual of fumigation for insect control. This substance has no effective antidote and the incidence of deaths due to its poisoning is increasing day by day in Iran. About 50 g of homogenized liver tissue or mixed stomach content was put into a steam distillation flask. 4. 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. There are many studies which described strong association between suicide mortality and a disease (mental or physical).3740 Suicide may be attempted by taking solid phosphides by mouth. The profile of acute poisonings in Haryana: Rohtak study. The purpose of the present study was to investigate phosphine poisoning-related deaths in Tehran, Iran in an 8-year interval. The manner of death was reported to be suicidal in 87% of the cases by Dalbir et al. FAO Corporate Document Repository. Dalbir S, Indarjit D, Vashisht R. Aluminium phosphide poisoning autopsy and histopathological findings. Siwach SB, Yadav DR, Arora B, Dalal S, Jagdish Acute aluminium phosphide poisoning An epidemiological, clinical and histopathological study. All the internal organs were congested with petechial hemorrhages. HS-GC/NPD technique is used as a confirmatory method for silver nitrate and ammonium molybdate tests in the present study. Similarly the involvement of young age group with phosphide poisoning was recorded by other studies.22,4749 No significant difference in the number of deaths was seen in different seasons. According to the results of the present study, 2007 cases of phosphine poisoning-related deaths were referred for death investigation to Legal Medicine Organization, Tehran, Iran. Following oral ingestion, AlP reacts with water and stomach acid to produce phosphine gas, which may account in large part for its observed toxicity. (Chopra et al., 1986). Acute phostoxin poisoning. Phosphides, like phosphine, are toxic to the central nervous system, which is excited and then depressed. (ed. Therefore, there is a growing need to substitute safer agents instead of metal phosphides and change the formulation available in Iran market. Resource document. Peshin SS, Srivastava A, Halder N, et al. Despite Asian countries, AlP is only available for qualified users in European countries such as UK, thus suicide by AlP ingestion is rare.21. 28. There on arrival he gave his details, fell unconscious and later succumbed to the effects of the poison, which was identified by the remaining unused tablets later recovered from his luggage at the hotel. 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. By continuing to use this website you are giving consent to cookies being used. Gupta BD, Hapani JH, Shah VN. Similarly to the phosphine results, aluminium concentrations were found to be higher in the brain, adrenals, and liver. Hajouji-Idrissi et al45 reported 28 cases of AlP poisoning admitted in a hospital in Morocco in a 10-year study. 46. A piece of silver nitrate impregnated paper was put at the orifice of distillation flask. 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. 52. Forensic autopsy reports and laboratory analysis sheets were reviewed from 2006 to 2013 to collect demographic data and other information needed to perform the present study. 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. Before 31. Aluminium phosphide poisoning present status and management. Aluminium phosphide poisoning, autopsy findings. 47. Poisoning with AlP has often occurred in attempts to commit suicide, and that more often in adults than in teenagers. Aluminum phosphide (AlP) and zinc phosphide are effective fumigant pesticides and are used throughout the world to protect stored grains during storage and transportation from pests and rodents.1,2 AlP exists as yellowish to dark gray granular or powdered solid which is formulated as tablets, pellets, or small sachets of powder. Learn more Aluminium phosphide is marketed in India as tablets of Celphos, Quickphos, etc. We believe that free access of celphos tablets in grain markets should be prohibited by law. Current trend of poisoning in Jamnagar. Bethesda, MD 20894, Web Policies The age group most commonly affected was 1625 years (49%). 1. Diagnosis of phosphine poisoning was based on the history given by relatives, autopsy examination, hospital reports, and finally toxicology analyses. HHS Vulnerability Disclosure, Help According to Karamjit et al. Bolter C, Chefurka W. Extra mitochondrial release of hydrogen peroxide from insects and mouse liver mitochondria using respiratory inhibitors--phosphine, nyxothiazol, antimycin and spectral analysis of inhibited cytochromes. This substance is not legally available for purchase by general public in Iran, although these tablets are imported to Iran illegally from other countries and are available in many herbal drug stores in tablet forms mostly packaging in aluminum cylindrical containers. Sabino B, Rozenbaum H, Oliveira A. Bogle RG, Theron P, Brooks P, et al. and 100% in Jain et al. The mean age (standard deviation) of cases was 26.82 (10.58) years with the age range of 5 to 74 years. Cecil 9000 spectrophotometer was used to detect carboxyhemoglobine in blood samples. Information needed in the present study was based on previous autopsy and analytical toxicology reports, thus no ethical approval and patient consent are required. sharing sensitive information, make sure youre on a federal Aluminium phosphide ingestion. 12. PMC legacy view The mixture was distilled. To address any sources of bias in determining the actual cause of death, systematic toxicological analyses were performed on liver, bile, stomach content, blood, and vitreous humor collected at autopsy examination in Forensic Toxicology Laboratory, Legal Medicine Organization, Tehran, Iran. On post-mortem examination, cyanosis was present over the nail bed. 8600 Rockville Pike Idali B, Miguil M, Moutawakkil S, et al. Murali R, Bhalla A, Singh D, et al. 54. 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). 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. Phosphine is widely absorbed from the gastrointestinal tract. Thin-layer chromatography (TLC) technique was used as screening test for the qualitative analysis of drugs, poisons, and opioid alkaloids from biological matrices. Mishra UK, Tripathi AK, Pandey R. The spectrum of phosphine toxicity in India. National Library of Medicine Saleki S, Ardalan FA, Javidan-Nejad A. Liver histopathology of fatal phosphine poisoning. 9. Some error has occurred while processing your request. Mortality is higher in those who consume more than two tablets and none of the patients survived who had ingested more than 3 tablets (Siwach et al., 1988; Singh et al., 1985; Raman et al. Aluminum phosphide fatalities at mild exertion in asymptomatic children: a clue to understand the variations of the autopsy findings.