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Therapeutic role of hyperinsulinemia/euglycemia in aluminum phosphide poisoning.

Hassanian-Moghaddam H, Zamani N - Medicine (Baltimore) (2016)

Bottom Line: The 2 groups were then compared regarding the signs and symptoms of toxicity and their progression, development of complications, and final outcome to detect the possible effect of GIK protocol on the patients' course of toxicity and outcome.Using GIK protocol resulted in significantly longer hospital stays (24 vs 60 hours; P < 0.001) and better outcomes (72.7% vs 50% mortality; P = 0.03).The risk of mortality decreased by 4.5% each hour after initiation of GIK.

View Article: PubMed Central - PubMed

Affiliation: aToxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences bExcellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.

ABSTRACT

Background: Different protocols have been suggested to treat aluminum phosphide (ALP) poisoning. We aimed to evaluate the possible therapeutic effect of hyperinsulinemia/euglycemia (HIE) in treatment of ALP poisoning.

Methods: In a prospective interventional study, a total of 88 ALP-poisoned patients were included and assigned into HIE group undergoing glucose/insulin/potassium (GIK) protocol and a control group that was managed by routine conventional treatments. The 2 groups were then compared regarding the signs and symptoms of toxicity and their progression, development of complications, and final outcome to detect the possible effect of GIK protocol on the patients' course of toxicity and outcome.

Results: The 2 groups were similar in terms of demographic characteristics and on-arrival vital signs and lab tests. Using GIK protocol resulted in significantly longer hospital stays (24 vs 60 hours; P < 0.001) and better outcomes (72.7% vs 50% mortality; P = 0.03). Regression analysis showed that GIK duration was an independent variable that could prognosticate mortality (odds ratio [95% confidence interval] = 1.045 [1.004,1.087]). The risk of mortality decreased by 4.5% each hour after initiation of GIK.

Conclusion: GIK protocol improves the outcome of ALP poisoning and increases the length of hospital stay.

No MeSH data available.


Related in: MedlinePlus

Patients allocation into intervention/control groups.
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Figure 1: Patients allocation into intervention/control groups.

Mentions: Between 2006 and 2012, sampling was conveniently performed. Whenever the authors were on shift and available at hospital and confirmed ALP poisoning in referred cases, the senior attending physician (first author) visited the patients and entered them into intervention group. There was no gender preference for the allocation. When other attending physicians of the department were on shift, patients were included in the conventional therapy group (control group). Written consent forms were taken from the patients or their next of kin if they were included in the intervention group. All relevant information pack was provided to next of kin and the patients. Patients with a positive history of ALP exposure with either a positive SNT result or a systolic blood pressure (SBP) of <80 mm Hg/a serum bicarbonate level of 15 meq/L or less/a pH of 7.2 or less were considered to be ALP-poisoned and included (Fig. 1). Actually, SNT was done in all patients but since it is a relatively low-sensitive test and may be falsely negative in some patients, the patients were also considered to be ALP-poisoned if they gave the history of ALP ingestion and developed hypotension or had abnormal pH and bicarbonate levels even with a negative SNT. Even if the patients had no such manifestations on presentation but developed them during their hospitalization period, they were included. They were otherwise excluded. Also, if the patients died within 2 hours of admission (whether in the intervention or in the control group), they were excluded. This was mainly due to the fact that we thought the patients in the intervention group needed up to 2 hours to show the effects of GIK protocol.


Therapeutic role of hyperinsulinemia/euglycemia in aluminum phosphide poisoning.

Hassanian-Moghaddam H, Zamani N - Medicine (Baltimore) (2016)

Patients allocation into intervention/control groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979794&req=5

Figure 1: Patients allocation into intervention/control groups.
Mentions: Between 2006 and 2012, sampling was conveniently performed. Whenever the authors were on shift and available at hospital and confirmed ALP poisoning in referred cases, the senior attending physician (first author) visited the patients and entered them into intervention group. There was no gender preference for the allocation. When other attending physicians of the department were on shift, patients were included in the conventional therapy group (control group). Written consent forms were taken from the patients or their next of kin if they were included in the intervention group. All relevant information pack was provided to next of kin and the patients. Patients with a positive history of ALP exposure with either a positive SNT result or a systolic blood pressure (SBP) of <80 mm Hg/a serum bicarbonate level of 15 meq/L or less/a pH of 7.2 or less were considered to be ALP-poisoned and included (Fig. 1). Actually, SNT was done in all patients but since it is a relatively low-sensitive test and may be falsely negative in some patients, the patients were also considered to be ALP-poisoned if they gave the history of ALP ingestion and developed hypotension or had abnormal pH and bicarbonate levels even with a negative SNT. Even if the patients had no such manifestations on presentation but developed them during their hospitalization period, they were included. They were otherwise excluded. Also, if the patients died within 2 hours of admission (whether in the intervention or in the control group), they were excluded. This was mainly due to the fact that we thought the patients in the intervention group needed up to 2 hours to show the effects of GIK protocol.

Bottom Line: The 2 groups were then compared regarding the signs and symptoms of toxicity and their progression, development of complications, and final outcome to detect the possible effect of GIK protocol on the patients' course of toxicity and outcome.Using GIK protocol resulted in significantly longer hospital stays (24 vs 60 hours; P < 0.001) and better outcomes (72.7% vs 50% mortality; P = 0.03).The risk of mortality decreased by 4.5% each hour after initiation of GIK.

View Article: PubMed Central - PubMed

Affiliation: aToxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences bExcellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.

ABSTRACT

Background: Different protocols have been suggested to treat aluminum phosphide (ALP) poisoning. We aimed to evaluate the possible therapeutic effect of hyperinsulinemia/euglycemia (HIE) in treatment of ALP poisoning.

Methods: In a prospective interventional study, a total of 88 ALP-poisoned patients were included and assigned into HIE group undergoing glucose/insulin/potassium (GIK) protocol and a control group that was managed by routine conventional treatments. The 2 groups were then compared regarding the signs and symptoms of toxicity and their progression, development of complications, and final outcome to detect the possible effect of GIK protocol on the patients' course of toxicity and outcome.

Results: The 2 groups were similar in terms of demographic characteristics and on-arrival vital signs and lab tests. Using GIK protocol resulted in significantly longer hospital stays (24 vs 60 hours; P < 0.001) and better outcomes (72.7% vs 50% mortality; P = 0.03). Regression analysis showed that GIK duration was an independent variable that could prognosticate mortality (odds ratio [95% confidence interval] = 1.045 [1.004,1.087]). The risk of mortality decreased by 4.5% each hour after initiation of GIK.

Conclusion: GIK protocol improves the outcome of ALP poisoning and increases the length of hospital stay.

No MeSH data available.


Related in: MedlinePlus