Protective effects of N-acetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning

Clin Toxicol (Phila). 2013 Jan;51(1):23-8. doi: 10.3109/15563650.2012.743029. Epub 2012 Nov 14.

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).

Conclusion: NAC may have a therapeutic effect in acute aluminum phosphide poisoning.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcysteine / administration & dosage
  • Acetylcysteine / therapeutic use*
  • Adolescent
  • Adult
  • Aluminum Compounds / administration & dosage
  • Aluminum Compounds / antagonists & inhibitors*
  • Aluminum Compounds / toxicity
  • Antioxidants / administration & dosage
  • Antioxidants / analysis
  • Antioxidants / therapeutic use*
  • Biomarkers / blood
  • Electron Transport Complex IV / antagonists & inhibitors*
  • Enzyme Inhibitors / administration & dosage
  • Enzyme Inhibitors / chemistry*
  • Enzyme Inhibitors / toxicity
  • Female
  • Humans
  • Infusions, Intravenous
  • Iran
  • Length of Stay
  • Lipid Peroxidation / drug effects
  • Male
  • Malondialdehyde / blood
  • Oxidative Stress / drug effects*
  • Pesticides / antagonists & inhibitors*
  • Pesticides / toxicity
  • Phosphines / administration & dosage
  • Phosphines / antagonists & inhibitors*
  • Phosphines / toxicity
  • Suicide, Attempted
  • Young Adult

Substances

  • Aluminum Compounds
  • Antioxidants
  • Biomarkers
  • Enzyme Inhibitors
  • Pesticides
  • Phosphines
  • Malondialdehyde
  • aluminum phosphide
  • Electron Transport Complex IV
  • Acetylcysteine