Heidari, R.; Niknahad, H.; Jangjoo, A.; Asghari, V. Antidotal Effect of Dihydroxyacetone in Aluminum Phosphide-Intoxicated Patients. Preprints2023, 2023030231. https://doi.org/10.20944/preprints202303.0231.v1
APA Style
Heidari, R., Niknahad, H., Jangjoo, A., & Asghari, V. (2023). Antidotal Effect of Dihydroxyacetone in Aluminum Phosphide-Intoxicated Patients. Preprints. https://doi.org/10.20944/preprints202303.0231.v1
Chicago/Turabian Style
Heidari, R., Ali Jangjoo and Vahidreza Asghari. 2023 "Antidotal Effect of Dihydroxyacetone in Aluminum Phosphide-Intoxicated Patients" Preprints. https://doi.org/10.20944/preprints202303.0231.v1
Abstract
Background: Aluminum phosphide (AlP), also known as “rice tablet,” is widely used as an effective pesticide. However, AlP poisoning is a common cause of mortality in many countries, such as Iran. Unfortunately, there is no specific antidote for AlP toxicity to date. AlP releases phosphine gas when it is exposed to moisture and acid. Phosphine is a robust mitochondrial toxin that could significantly inhibit cellular energy metabolism. AlP poisoning is an emergency condition that needs instant and effective intervention. Dihydroxyacetone (DHA) is a simple saccharide used for several pharmacological as well as cosmetic purposes. Previously, we found that DHA could significantly prevent mitochondrial impairment induced by toxic agents such as cyanide and phosphine in various in vitro and in vivo experimental models.Methods: Hospitalized patients (n = 111) were evaluated for eligibility criteria. Among these patients, n = 35 cases were excluded due to incomplete data (n = 11) and suspicion of poisoning rather than AlP (n = 24). Meanwhile, n = 76 cases with confirmed AlP poisoning were included in the study. AlP-poisoned patients who did not receive DHA (n =18) were used as the control group.Patients (n = 58) received at least one dose of DHA (500 ml of 5% DHA solution w/v, i.v.) in addition to routine treatment of AlP poisoning. Arterial blood gas (ABG), blood pH, bicarbonate levels, and other vital signs and biochemical measurements were monitored. Moreover, the mortality rate and time of hospitalization were evaluated in both DHA-treated (n = 58) and AlP-poisoned patients without DHA administration (n = 18). Several biomarkers were assessed before (upon hospitalization) and after DHA treatment. The routine tests for AlP-poisoned patients in this study were the measurement of electrolytes (K+ and Na+), WBC, RBC, hemoglobin, INR, carbonate (HCO3), blood pH, PaCO2, and PaO2 and SGPT, SGOT, BUN, Cr. Results: Upon patients' admission, significant decreases in blood pH (acidosis), blood PaO2, and HCO3 levels were the hallmarks of AlP poisoning. It was found that DHA significantly alleviated biomarkers of AlP poisoning and tremendously enhanced patients’ survival rate compared to patients treated based on hospital routine AlP poisoning protocols (no DHA). No significant adverse effects were evident in DHA-treated patients in the current study.Interpretation: These data suggest that parenteral DHA is a novel and effective antidote against AlP poisoning.Trial registration: IR.SUMS.REC.1394.102
Medicine and Pharmacology, Pharmacology and Toxicology
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The commenter has declared there is no conflict of interests.
Comment:
Dear Readers
In this manuscrript (As you can see when download its PDF version), Prof. Hossein Niknahad is the correspondence and first author.
Readers Could directly contact him by e-mail for any questions:
niknahadh@sums.ac.ir
Commenter:
The commenter has declared there is no conflict of interests.
In this manuscrript (As you can see when download its PDF version), Prof. Hossein Niknahad is the correspondence and first author.
Readers Could directly contact him by e-mail for any questions:
niknahadh@sums.ac.ir