title: Elevated Carboxyhaemoglobin Concentrations by Pulse CO-Oximetry is Associated with Severe Aluminium Phosphide Poisoning.
abstract: In pulse CO-oximetry of aluminium phosphide (ALP)-poisoned patients, we discovered that carboxyhaemoglobin (CO-Hb) level was elevated. We aimed to determine whether a higher CO level was detected in patients with severe ALP poisoning and if this could be used as a prognostic factor in these patients. In a prospective case-control study, 96 suspected cases of ALP poisoning were evaluated. In the ALP-poisoned group, demographic characteristics, gastric and exhalation silver nitrate test results, average CO-Hb saturation, methaemoglobin saturation, and blood pressure and blood gas analysis until death/discharge were recorded. Severely poisoned patients were defined as those with systolic blood pressure ≤80 mmHg, pH ≤7.2, or HCO3 ≤15 meq/L or those who died, while patients with minor poisoning were those without any of these signs/symptoms. A control group (37 patients) was taken from other medically ill patients to detect probable effects of hypotension and metabolic acidosis on CO-Hb and methaemoglobin saturations. Of 96 patients, 27 died and 37 fulfilled the criteria for severe poisoning. All patients with carbon monoxide saturation >18% met the criteria to be included in the severe poisoning group and all with a SpCO >25% died. Concerning all significant variables in univariate analysis of severe ALP toxicity, the only significant variable which could independently predict death was carbon monoxide saturation. Due to high mortality rate and need for intensive care support, early prediction of outcome is vital for choosing an appropriate setting (ICU or ordinary ward). CO-oximetry is a good diagnostic and prognostic factor in patients with ALP poisoning even before any clinical evidence of toxicity will develop.
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mashayekhian
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Hassanian-Moghaddam
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.
authors.forename: Mitra
authors.initials: M
authors.lastname: Rahimi
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.
authors.forename: Nasim
authors.initials: N
authors.lastname: Zamani
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|Department of Forensic Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Aghabiklooei
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.
authors.forename: Shahin
authors.initials: S
authors.lastname: Shadnia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017607:Aluminum Compounds / Q000097:blood / Q000506:poisoning*; D001784:Blood Gas Analysis; D002248:Carbon Monoxide / Q000097:blood; D002249:Carbon Monoxide Poisoning / Q000097:blood / Q000175:diagnosis*; D002263:Carboxyhemoglobin / Q000737:chemistry*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010720:Phosphines / Q000097:blood / Q000506:poisoning*; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D017607:Aluminum Compounds; D010720:Phosphines; D002248:Carbon Monoxide; D002263:Carboxyhemoglobin; C001864:aluminum phosphide