The effects of amiodarone prophylaxis on cardiac dysrhythmia in acute aluminium phosphide poisoning

Open access


Cardiovascular toxicity is the most common cause of fatality in the first 24 hours of poisoning with aluminium phosphide (AlP). Most often manifesting itself in cardiac dysrhythmias. The aim of this study was to evaluate the benefits of amiodarone prophylaxis against cardiac dysrhythmia in 46 patients with acute AlP poisoning. They were divided in two groups of 23: one receiving amiodarone and the other not (control). The treatment group received amiodarone prophylaxis in the initial intravenous bolus dose of 150 mg, followed by a drip of 1 mg/min for six hours and then of 0.5 mg/min for eighteen hours. Both groups were Holter-monitored for 24 hours since admission. Save for amiodarone, both groups received the same standard treatment. Amiodarone had a significant beneficial effect in reducing the frequency of ST-segment elevation and ventricular fibrillation plus atrial fibrillation (P=0.02 and P=0.01, respectively), but the groups did not differ significantly in mortality (9 vs 11 patients, respectively). The mean time between ICU admission and death (survival time) was significantly longer in the treatment group (22 vs 10 h, respectively; P=0.03). Regardless its obvious limitations, our study suggests that even though amiodarone alone did not reduce mortality, it may provide enough time for antioxidant therapy to tip the balance in favour of survival and we therefore advocate its prophylactic use within the first 24 h of AlP poisoning.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol 2009;47:89-100. doi: 10.1080/15563650802520675

  • 2. Soltaninejad K Nelson LS Bahreini SA Shadnia S. Fatal aluminum phosphide poisoning in Tehran-Iran from 2007 to 2010. Indian J Med Sci 2012;66:66-70. PMID: 23603623

  • 3. Shadnia S Sasanian G Allami P Hosseini A Ranjbar A Amini-Shirazi N Abdollahi M. A retrospective 7-years study of aluminum phosphide poisoning in Tehran: opportunities for prevention. Hum Exp Toxicol 2009;28:209-13. doi: 10.1177/0960327108097194

  • 4. Soltaninejad K Faryadi M Sardari F. Acute pesticide poisoning related deaths in Tehran during the period 2003-2004. J Forensic Leg Med 2007;14:352-4. doi: 10.1016/j.jflm.2006.12.011

  • 5. Shadnia S Mehrpour O Soltaninejad K. A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome. Indian J Med Sci 2010;64:532-39. PMID: 21258160

  • 6. Mathai A Bhanu MS. Acute aluminium phosphide poisoning: Can we predict mortality? Indian J Anaesth 2010;54:302-7. doi: 10.4103/0019-5049.68372

  • 7. Soltaninejad K Beyranvand MR Momenzadeh SA Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. J Forensic Leg Med 2012;19:291-93. doi: 10.1016/j.jflm.2012.02.005

  • 8. Alter P Grimm W Maisch B. Lethal heart failure caused by aluminium phosphide poisoning. Intensive Care Med 2001;27:327. PMID: 11280664

  • 9. Taghaddosinejad F Farzaneh E Ghazanfari-Nasrabad M Eizadi-Mood N Hajihosseini M Mehrpour O. The effect of N-acetyl cysteine (NAC) on aluminum phosphide poisoning inducing cardiovascular toxicity: a case-control study. Springerplus 2016;5:1948. doi: 10.1186/s40064-016-3630-2

  • 10. Moghadamnia AA. An update on toxicology of aluminum phosphide. DARU 2012;20:25. doi: 10.1186/2008-2231-20-25

  • 11. Naccarelli GV Wolbrette DL Patel HM Luck JC. Amiodarone: clinical trials. Curr Opin Cardiol 2000;15:64-72. PMID: 10666663

  • 12. Brendorp B Pedersen O Torp-Pedersen C Sahebzadah N Køber L. A benefit-risk assessment of class III antiarrhythmic agents. Drug Saf 2002;25:847-65. doi: 10.2165/00002018-200225120-00003

  • 13. Susla GM Suffredini AF McAreavey D Solomon MA Hoffman WD Nyquist P Ognibene FP Shelhamer JH Masur H editors. Handbook of Critical Care Drug Therapy. Philadelphia: Lippincott Williams & Wilkins; 2006.

  • 14. Jadhav AP Nusair MB Ingole A Alpert MA. Unresponsive ventricular tachycardia associated with aluminum phosphide poisoning. Am J Emerg Med 2012;30:633.e3-5. doi: 10.1016/j.ajem.2011.01.026

  • 15. Siwach SB Singh H Jagdish Katyal VK Bhardwaj G. Cardiac arrhythmias in aluminium phosphide poisoning studied by on continuous holter and cardioscopic monitoring. J Assoc Physicians India 1998;46:598-601. PMID: 12152839

  • 16. Jafari A Baghaei A Solgi R Baeeri M Chamanara M Hassani S Gholami M Ostad SN Sharifzadeh M Abdollahi M. An electrocardiographic molecular and biochemical approach to explore the cardioprotective effect of vasopressin and milrinone against phosphide toxicity in rats. Food Chem Toxicol 2015;80:182-92. doi: 10.1016/j.fct.2015.02.022

  • 17. Baghaei A Solgi R Jafari A Abdolghaffari AH Golaghaei A Asghari MH Baeeri M Ostad SN Sharifzadeh M Abdollahi M. Molecular and biochemical evidence on the protection of cardiomyocytes from phosphine-induced oxidative stress mitochondrial dysfunction and apoptosis by acetyl-L-carnitine. Environ Toxicol Pharmacol 2016;42:30-7. doi: 10.1016/j.etap.2015.12.019

  • 18. Azad A Lall SB Mittra S. Effect of N-acetylcysteine and L-NAME on aluminium phosphide induced cardiovascular toxicity in rats. Acta Pharmacol Sin 2001;22:298-304. PMID: 11742581

Journal information
Impact Factor

IMPACT FACTOR 2018: 1.436
5-year IMPACT FACTOR: 1.606

CiteScore 2018: 1.53

SCImago Journal Rank (SJR) 2018: 0.358
Source Normalized Impact per Paper (SNIP) 2018: 0.608

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 425 425 58
PDF Downloads 303 303 28