Phosphine Gas Poisoning: A Case Report

ABSTRACT

In agrarian countries, several pesticides are used on a large scale to preserve grains. However, oftentimes, the very people using it are not aware of their harmful effects. Some pesticides produce toxic gases, which can cause poisoning by inhalation. With no specific antidotes and limited data on the benefit of therapeutic interventions, such poisonings can lead to fatalities. This case report discusses the death of an apparently healthy, 6-year-old boy who presented with multiple episodes of vomiting and loose stools and was declared dead on arrival to the hospital. His other siblings and the parents also experienced similar symptoms but survived. Further investigation revealed that the family lived in a closed, poorly ventilated room adjacent to a granary where their landlord stored grains with pesticides for the purpose of preservation. However, during rainy season, moisture came into contact with the grains and toxic gases were released. The family was exposed to these gases through a small window in the living room, proving fatal to one member of the family. This article suggests that phosphine gas was liberated from an aluminum phosphide pesticide and emphasizes the need for improved knowledge, recognition, prevention, and management in such scenario.

[Investigation of an acute hydrogen sulfide mixture gas poisoning in a confined space]

Hydrogen sulphide poisoning is an acute poisoning event that occurs frequently in summer. A case of acute hydrogen sulphide poisoning in a confined space in August 2018 was investigated and clinical data were analyzed. This is a typical case of acute hydrogen sulfide gas poisoning in a confined space. The main cause of the accident is the lack of occupational protection and illegal rescue. Among the 5 patients, 3 died, 1 patient had long-term sequelae of nervous system damage such as cortical blindness, and 1 patient was cured.

[Investigation and analysis of a mass ammonia gas poisoning accident]

Objective: To investigation and analysis of ammonia gas leakage in a meat factory. Methods: In April 2013, Enterprise managers and workers were investigated, and clinical data of 24 patients were analyzed. Results: The company caused a leak in the ammonia pipeline maintenance operation, Among the patients, 20 had stimulus response and 4 had mild poisoning. Conclusion: To prevent group occupational ammonia poisoning, it is necessary to strengthen the awareness of occupational disease prevention of enterprise owners and the awareness of self-protection of workers.

Poisoning-induced Out-of-Hospital Cardiac Arrest and Outcomes according to Poison Agent

It is unclear whether specific agent groups are associated with outcomes in cases of poisoning-induced out-of-hospital cardiac arrest (P-OHCA). The study population comprised cases of confirmed P-OHCA drawn from the national out-of-hospital cardiac arrest (OHCA) registry (2008-2013). Exposures were categorized into five groups according to the International Classification of Disease, 10th version: group 1, prescribed drugs; group 2, vapors and gases; group 3, pesticides; group 4, alcohol and organic solvents; and group 5, other poisons. The outcome was survival to discharge and good neurological recovery. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to test the association between specific groups and outcomes. A total of 2,083 patients were analyzed; group 1 (10.3%), group 2 (23.6%), group 3 (52.9%), group 4 (1.4%), and group 5 (13.2%). The survival to discharge and good neurological recovery rates were 3.3%/1.3% for all patients, 10.3%/5.6% (group 1), 6.9%/3.4% (group 2), 2.4%/0.4% (group 3), 2.2%/1.0% (group 4), and 3.3%/2.4% (group 5) (all P < 0.001). The aORs (95% CIs) of groups 2-5 compared with group 1 for survival to discharge were 0.47 (0.09-2.51), 0.34 (0.17-0.68), 0.33 (0.14-0.77), and 0.31 (0.13-0.77), respectively. The odds ratios (95% CIs) for good neurological recovery were significant only in group 1, the pesticides group (0.07 [0.02-0.26]) and were not significant in the other groups. P-OHCA outcomes differed significantly among the poisoning agent groups. The pesticides group showed the worst outcomes, followed by the group of vapors or gases.

Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

OBJECTIVES

To investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls.

DESIGN

A retrospective, observational study.

SETTING

Osaka City, Japan.

PARTICIPANTS

A total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013.

PRIMARY OUTCOME MEASUREMENTS

The definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls.

RESULTS

Multivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene.

CONCLUSIONS

Ambulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene.

Method development and validation for determining 1,3-butadiene in human blood by gas chromatography-mass spectrometry and head-space gas chromatography

To develop a simple, validated method for identifying and quantifying 1,3-butadiene (BD) in human blood by gas chromatography-mass spectrometry (GC-MS) and head-space gas chromatography (HS-GC). BD was identified by GC-MS and HS-GC, and quantified by HS-GC. The method showed that BD had a good linearity from 50 to 500 microg/mL (r > 0.99). The limits of detection and quantification were 10 microg/mL and 50 microg/mL, respectively. Both the intra-day precision and inter-day precision were < 6.08%, and the accuracy was 96.98%-103.81%. The method was applied to an actual case, and the concentration of BD in the case was 242 microg/mL in human blood. This simple method is found to be useful for the routine forensic analysis of acute exposure to BD.

Self-Administration of Pralidoxime in Nerve Gas Poisoning with A Note on the Stability of the Drug

Plasma concentrations of pralidoxime methane sulphonate (P2S) have been determined in man after self-administration by an automatic injector. After administration of 10 mg./kg. P2S in a 50 per cent w/v solution, concentrations over 4 μg./ml. were reached within 6 min. and maintained for about 90 min. After 20 mg./kg., plasma concentrations over 4 μg./ml. were maintained for about 170 min. Except for pain at the site of injection, which disappeared after a few hr., no serious side reactions could be detected. The drug can be stored for 5 years at 5° with less than 7 per cent decomposition. The decomposition products were found to be less toxic than the unchanged oxime. N-Methylpyridinium-2-carboxamide was identified as a major degradation product.

[Genetic damages in somatic and germ cells from patients of benzene poisoning, asbestosis and gas poisoning.]

OBJECTIVE

To compare the extent of genetic damages in somatic and germ cells from patients of benzene poisoning, silicosis and gas poisoning, which may provide clues for protection and reproductive healthcare.

METHODS

174 patients with three types of occupational disease (including 48 with benzene poisoning, 71 with silicosis and 55 with gas poisoning) and 80 healthy controls had their aberrant chromosome and micronuclei rates measured with routine methods. Male patients also had their sperm samples measured for sperm abnormities and de novo mutations.

RESULTS

The aberrant chromosome rate, micro-nuclei rate and sperm abnormity were as followed: benzene poisoning 0.4%, 1.52 per thousand, (62 +/- 14%), silicosis 0.51%, 2.31 per thousand, (41 +/- 7%), harmful gas poisoning 0.42%, 1.55 per thousand, (48 +/- 8%), all being significantly higher than those of the controls [0.20%, 0.34 per thousand, (27 +/- 5)%]. The aberrant chromosome and micro-nuclei rates of silicosis group were higher than other two groups, but without statistical significance. Sperm abnormity of benzene poisoning group was significantly higher than that of other groups. In addition, de novo mutations in sperm of benzene poisoning group were detected.

CONCLUSION

Patients with the studied occupational diseases not only have genetic damage in their somatic cells, but also acquire de novo mutations in germ cells.

Acute poisonings in Poland

The pattern of adolescent and adult poisonings in Poland is presented on the basis of the data from the regional toxicological centers (in-patient treatment centers). Drugs were the most frequent group of chemical substances, responsible for more than 50% of all admissions for acute poisonings. The second most frequent were alcohols with an increase in poisoning by alcohols to about 20% of total poisonings. Carbon monoxide was the third most frequent cause of poisonings. The percentages of poisonings by pesticides, corrosives and metal compounds have been reduced in recent years. The greatest number of lethal outcomes was also due to poisonings by alcohols, drugs, and carbon monoxide.

SARA three years later. Emergency physician's knowledge, beliefs, and actions

OBJECTIVE

Investigate Emergency Physicians' knowledge about the Superfund Amendments and Reauthorization Act (SARA) Title III legislation, passed by the United States Congress in 1986, and to determine the factors contributing to their level of preparedness in dealing with patients exposed to toxic chemicals.

METHODS

A 115-item questionnaire was mailed to the medical directors of all emergency departments (EDs) in the State of New York. The results of the cross-sectional survey were analyzed using standard statistical methods.

RESULTS

One hundred and eighty-seven (72%) of the directors of EDs in New York State responded to the survey. Three years after SARA was enacted, only 33% of the directors had heard about this legislation. Only 18% had been invited to attend the meetings of the Local Emergency Planning Committees (LEPC). Sixty percent of the directors knew whether or not the LEPC had devised plans that defined a role for their EDs in responding to environmental emergencies. This knowledge about community planning mainly had an effect on preparedness of the EDs. Preparedness also was predicted by how recently the EDs had treated patients exposed to toxic chemicals, the perception that emergency physicians had a legitimate role in planning for and responding to chemical emergencies, and how often emergency physicians had attended continuing education courses about hazardous materials.

CONCLUSION

Despite the finding that some emergency physicians are involved in community preparations, two main problems persist in planning a medical response to environmental emergencies. First, the ED directors generally are unaware of the legislation that mandates these preparations and are not interacting with community planners. Second, there is not full involvement by the local EDs in the LEPC planning efforts.

RECOMMENDATIONS

A procedure is needed to disseminate information about legislation which affects emergency physicians, such as SARA, and about regional planning for environmental emergencies. Dissemination should include education about the professions' role in planning for and providing care for patients exposed to toxic chemicals.

Behavioral and psychological responses to chemical and biological warfare

Understanding the behavioral and psychological responses in a chemical environment is critical to individual health and unit functioning. Reports of incidents of acute nerve agent and other organophosphate exposures and of repeated low-dose toxic exposures can provide information about psychiatric symptomatology, performance disruption, and recovery. This paper presents a review of the literature on the longer term consequences of acute and chronic exposure to nerve agents and other organophosphates. In addition, reports on psychological responses during chemical warfare training are reanalyzed to identify behavioral and psychological casualties attributed to the unique stressors of the CBW environment.

Modern medicine and war: didn't we do well?

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[Risk of accidents to hospital personnel]

The industrial accident phenomenon among personnel on duty in the hospital ambit requires further studies, also for the distinctive aspects that it presents as regards that may be found in the factory. The authors, for this end, have conducted an analysis about industrial accidents happened in the hospitals of Parma in 1977 and in 1978, with reference to the different working qualifications, the sex and the age of the staff, the kind of the suffered lesion, the affected bodily seat and the traumatic event on the occasion of which the injury happened. Moreover distribution per hour of industrial accidents, in relation to shifts as well, their monthly and weekly incidence, compatibly with the difficulties of treatment of the analysis in connection with the heterogeneity, chronological too, of various working services, have been calculated. The above-mentioned survey indicates that the factors that cause a bigger risk of accident are individual factors - sex, age and job - and factors connected both with the kind of internal organization of work and with the structures of working place.

A doctor in the Great War--an interview with Sir Geoffrey Marshall

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