title: Protective effects of N-acetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning.
abstract: OBJECTIVE
  Aluminum phosphide is used as a fumigant. It produces phosphine gas (PH₃). PH₃ is a mitochondrial poison which inhibits cytochrome c oxidase, it leads to generation of reactive oxygen species; so one of the most important suggested mechanisms for its toxicity is induction of oxidative stress. In this regard, it could be proposed that a drug like N-acetylcysteine (NAC) as an antioxidant would improve the tolerance of aluminum phosphide-intoxicated cases. The objective of this study was to evaluate the protective effects of NAC on acute aluminum phosphide poisoning.
  
  
  METHODS
  This was a prospective, randomized, controlled open-label trial. All patients received the same supportive treatments. NAC treatment group also received NAC. The blood thiobarbituric acid reactive substances as a marker of lipid peroxidation and total antioxidant capacity of plasma were analyzed.
  
  
  RESULTS
  Mean ingested dose of aluminum phosphide in NAC treatment and control groups was 4.8 ± 0.9 g vs. 5.4 ± 3.3 g, respectively (p = 0.41). Significant increase in plasma malonyldialdehyde level in control group was observed (139 ± 28.2 vs. 149.6 ± 35.2 μmol/L, p = 0.02). NAC infusion in NAC treatment group significantly decreased malondialdehyde level (195.7 ± 67.4 vs. 174.6 ± 48.9 μmol/L, p = 0.03), duration of hospitalization (2.7 ± 1.8 days vs. 8.5 ± 8.2 days, p = 0.02), rate of intubation and ventilation (45.4% vs. 73.3%, p = 0.04). Mortality rate in NAC treatment and control groups were 36% and 60%, respectively with odds ratio 2.6 (0.7-10.1, 95% CI).
  
  
  CONCLUSIONS
  NAC may have a therapeutic effect in acute aluminum phosphide poisoning.
authors.affiliation: Faculty of Pharmacy, Islamic Azad University of Medical Sciences, Tehran, Iran.
authors.forename: Hiva
authors.initials: H
authors.lastname: Tehrani
authors.forename: Zahra
authors.initials: Z
authors.lastname: Halvaie
authors.forename: Shahin
authors.initials: S
authors.lastname: Shadnia
authors.forename: Kambiz
authors.initials: K
authors.lastname: Soltaninejad
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdollahi
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D017607:Aluminum Compounds / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000633:toxicity; D000975:Antioxidants / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D003576:Electron Transport Complex IV / Q000037:antagonists & inhibitors*; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000737:chemistry* / Q000633:toxicity; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007492:Iran; D007902:Length of Stay; D015227:Lipid Peroxidation / Q000187:drug effects; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D018384:Oxidative Stress / Q000187:drug effects*; D010575:Pesticides / Q000037:antagonists & inhibitors* / Q000633:toxicity; D010720:Phosphines / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000633:toxicity; D013406:Suicide, Attempted; D055815:Young Adult
chemical_list: D017607:Aluminum Compounds; D000975:Antioxidants; D015415:Biomarkers; D004791:Enzyme Inhibitors; D010575:Pesticides; D010720:Phosphines; D008315:Malondialdehyde; C001864:aluminum phosphide; D003576:Electron Transport Complex IV; D000111:Acetylcysteine