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Abstract
Objective: To determine the frequency of in-hospital survival among patients with acute aluminium phosphide (wheat-pill) poisoning receiving intravenous dextrose-containing supportive therapy in the Accident and Emergency Department of a tertiary care hospital.
Study Design: Prospective, observational case series.
Setting: Accident and Emergency Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi.
Period: January to April 2025.
Material & Methods: Ninety-five adult patients (≥18 years) with a compatible history and presentation of acute aluminium phosphide wheat-pill ingestion, who received physician-directed intravenous dextrose-containing supportive therapy, were enrolled by non-probability purposive sampling. Demographic, clinical, biochemical and treatment variables were recorded on a structured proforma. Data were coded and analysed in IBM SPSS Statistics v26. Continuous variables were tested for normality (Shapiro-Wilk) and reported as mean±SD or median (IQR); categorical variables as frequency/percentage. Survivors and non-survivors were compared using the independent-samples t-test/Mann-Whitney U test and chi-square/Fisher's exact test, and a parsimonious multivariable binary logistic regression was fitted for in-hospital survival. p≤0.05 was considered significant.
Results: In-hospital survival occurred in 42/95 patients (44.2%; 95% CI 34.6%-54.2%). Non-survivors presented with significantly higher pulse, respiratory rate, QTc, lactate and baseline glucose, and lower systolic/diastolic blood pressure, SpO2, GCS, pH and bicarbonate than survivors (all p<0.05), and had higher rates of shock, vasopressor requirement, mechanical ventilation, dysrhythmia and other major complications (all p<0.001). On multivariable logistic regression, systolic blood pressure (adjusted OR 1.11, 95% CI 1.05-1.17, p<0.001) and lactate (adjusted OR 0.57, 95% CI 0.34-0.96, p=0.033) were independent predictors of survival (Nagelkerke R²=0.70; model correctly classified 84.2% of cases).
Conclusion: Just under half of patients with acute aluminium phosphide poisoning receiving dextrose-containing supportive therapy survived to discharge, with presenting haemodynamic and metabolic severity not dextrose exposure itself driving in-hospital outcome. Early recognition of shock, acidosis and hyperlactataemia should guide triage and resource allocation.