Aluminum phosphide poisoning in Saudi Arabia over a nine-year period

Abstract

BACKGROUND: Aluminum phosphide (AlP) is an insecticide and rodenticide used to protect stored grains from rodents and other household pests. This substance is highly toxic to humans and has been the cause of many accidental and intentional deaths due in part to poor regulation of sales and distribution in many countries. OBJECTIVES: Describe poisonings reported to the Ministry of Health in Saudi Arabia in terms of demographic variables and by time and geographic distribution. DESIGN: Retrospective medical record review. SETTING: Ministry of Health hospitals nationwide. PATIENTS AND METHODS: Using a semi-structured checklist, data was collected from patient records that contained sociodemographic variables and the outcome (died or discharged). MAIN OUTCOME MEASURES: Aggregated data, summary statistics and statistical comparisons. SAMPLE SIZE: 68 patients. RESULTS: Thirty-eight (56%) were female and the mean (SD) age of patients was 18.6 (1.86) years. Eighteen of 22 (82%) patients who died were younger than 20 years old. Mortality in patients younger than 20 years of age was greater than in adults (P=.043). Mortality was highest in patients younger than 7 years of age (P=.006). The cases were reported by the Islamic years 1427-1435, corresponding approximately to Gregorian years 2006 to 2017. Fifty-six cases (83%) were reported from Jeddah. Most cases were due to accidental exposure to phosphine gas during fumigation. CONCLUSION: Mortality due to AlP poisoning was highest in children and most commonly occurred during fumigation of households. Delays in medical attention and diagnosis may have contributed to mortality. LIMITATIONS: Retrospective data collection and relatively small sample size. Data on exact amount and route of phosphide ingestion or exposure not available. CONFLICT OF INTEREST: None.