KMCH ICU UPDATE - 2010课件.ppt

ALUMINIUM PHOSPHIDE Fumigant pesticide Grain preservative Low cost, highly efficient No residual effect ALUMINIUM PHOSPHIDE POISIONING 16% of toxicology admission Male: female - 2:1 Age group - 15- 30 yrs Suicidal - 80% Mortality - 40 to 80% ALUMINIUM PHOSPHIDE POISIONING PROBLEMS Mechanism of action – not clear No specific antidote Lack of good literature support Treatment mainly supportive CLINICAL FEATURES ON INGESTION -CVS PROFOUND HYPOTENTION, SHOCK MYOCARDITIS ARRYTHMIAS HYPOTENSION BRADYCARDIA COMMON SHOCK- CARDIOGENIC,HYPOVOLEMIC PERIPHERAL CLINICAL FEATURES ON INGESTION –OTHERS CNS – RESTLESS,SEIZURES COMA RS – APO ARDS RENAL – ARF ORGAN SUPPORT ARF – HD OR CRRT APO ARDS - VENTILAION NO PROVEN BENEFIT MGS04 STEROIDS FORCED DIURESIS ALKANISATION ACE INHIBITORS VIT - C * DEPARTMENT OF CRITICAL CARE KMCH ICU UPDATE - 2010 ALUMINIUM PHOSPHIDE ORGANOCHLORINE POISONING CELPHOS or ALPHOS SOLID PELLETS(3GMS) NOW AVAILABLE IN 10GMS GRANULATED SACHETS FUMIGANT INSECTICIDE, RODENTICIDE PROPERTIES DARK BROWN OR GREYISH COLOUR HAS AlP(56) + Al2(CO)3 (44) AlP + 3H20 Al (OH)3+ PH3 (in air) AlP + 3HCl AlCl3 + PH3 (in air and stomach) PH3 – COLOURLESS / GARLICKY SMELL CELLULAR HYPOXIA ORGAN DAMAGE MODE OF ACTION ENTRY – INHALATION / INGESTION PH3 ENTERS CIRCULATION EXITS VIA BREATH URINE NON-COMPETITIVE INHIBITION OF CYTO C (MITO) MODE OF ACTION PERMISSIBLE LIMIT Permissible exposure limit (PET): 0.3 ppm over an 8 hr shift Short term exposure limit (STEL): 1 ppm Immediately dangerous to life and health: 200 ppm Lethal in 30 min: 400-600 ppm (10 mg/Kg AIP) ON INHALATION MILD - FATIGAUBILITY, NAUSEA, VOMITING, HEADACHE DIARRHOEA MODERATE - ATAXIA, NUMBNESS, PARAESTHESIA, MUSCLE WEAKNESS, DIPLOPIA, JAUNDICE SEVERE - ARDS, CCF, CONVULSIONS COMA CLINICAL FEATURES ON INGESTION -GIT NAUSEA , VOMITING