Evaluation of Apache-2 Scoring System to Predict Mortality Rate in Aluminum Phosphide Poisoning

Abstract

Background:Aluminumphosphateis a commonly available chemical and its poisoning is associated with high incidence of   mortality rate.

Objective:The objective of the study was to determine the clinical manifestations and prognosis of victims of wheat pill poisoning admitted in Intensive Care Units, of District Headquarter Hospital DG Khan, Pakistan.

Study Design: A prospective cohort study

Place & Duration of Study: By the Department of Forensic Medicine Department, Khyber Medical College, Peshawar, at Emergency Department in District Headquarter Hospital DG Khan, Pakistan; from October 2020 to Mar 2021.

Methodology:19 cases where examined and followed-up.Sampling technique: included in study was non-probability convenient sampling on patients admitted with history of accidental or suicidal wheat pills poisoning.Symptomatic treatment was initially given for 2-3 hours in emergency ward. The patients were retained in CCU for 24-36hours before shifting to ward. Research tool (proforma) was designed for collection and interpretation of data. Acute Physiology and Chronic Health Evaluation Score 2 (APACHE-2) score was used for prognosis and recovery.

Result: Out of 19 victims of aluminum phosphide ingestion male/female ratio was 1:4,21% (n= 4) were males and 79% (n=15) were females. Higher incidence was found in females, age group 16–25 years (n= 09 victims). Overall mortality was very high; 13 (68%) whereas predicted mortality rate was slightly higher that is 71%.

Conclusion:The wheat pill was apoison of choice among teens and adults in Pakistan. APACHE scoring was slightly over estimating the mortality rate. Arrhythmia and metabolic acidosis were the major causes of death after wheat pills ingestion. Coconut oil was found effective in delaying the absorption.