Exploring research gaps and trends in the management of acute phosphide poisoning: a systematic review

Abstract

Metal phosphides are highly toxic pesticides that result in high morbidities and mortalities worldwide. This systematic review included 350 studies that fulfilled the eligibility criteria. There were significant rising trends of studies on acute aluminum phosphide (AlP) and zinc phosphide (Zn₃P₂) poisoning (p-values = <.001), pointing to an increased number of phosphide-intoxicated patients. Acute AlP poisoning studies represented 81%, 89.3%, and 97.7% of all descriptive, analytical, and experimental interventional studies included in this review, respectively. High AlP poisoning mortality explains great research interest in AlP poisoning. Thus, after 2016, nearly half (49.7%) of studies on acute AlP poisoning were issued. Also, 78.82% of experimental interventional studies on AlP poisoning were published after 2016. The trends of in-vitro, animal, and clinical studies on AlP poisoning significantly increased with p-values equal to .021, <.001, and <.001, respectively. Seventy-nine treatment modalities for acute AlP poisoning were pooled from 124 studies; 39 management-related case reports, 12 in-vitro studies, 39 animal studies, and 34 clinical studies. All therapeutic modalities were summarized to formulate an integrated and comprehensive overview. For clinicians, therapeutic modalities significantly decreased mortality of acute AlP poisoning in clinical trials included extracorporeal membrane oxygenation (ECMO), N-acetyl cysteine (NAC), vitamin E, glucose-insulin-potassium (GIK) infusion, fresh packed RBCs infusion, and GIT decontamination using oils. However, meta-analyses are needed to provide solid evidence regarding their efficacies. To date, there is no effective antidote nor evidence-based standardized protocol for managing acute AlP poisoning. This article outlined the potential research gaps in phosphide poisoning that might promote and direct future medical research in this context.

Keywords:

• Metal phosphide poisoning
• aluminum phosphide
• zinc phosphide
• phosphine
• research gaps

Acknowledgment

The authors express their deep gratitude to Dr. Eman Saleh, Dr. Heidi Elsobky, Dr. Nehad Gad, the Assistant Lecturers in Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University and Clinical Toxicology specialists in Alexandria Poison Center (APC), Alexandria Main University Hospitals for their enthusiastic encouragement and useful critiques of this research work.

The kind support provided by Prof Dr. Mohamed Goma (Professor of Food Science at Alexandria University) and Dr. Mai Elgendy (Assistant Lecturer of Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University) in managing references using the EndNote is also acknowledged. The authors also thank Rasha Badry (statistics expert) for her contribution to the statistical analysis of this study.

We greatly appreciate the valuable comments offered by the Editor-in-Chief, Dr. Roger McClellan and the anonymous reviewers, which enhanced the quality and completeness of the article.

Declaration of interest

The employment affiliations of the authors are shown on the cover page. The authors’ affiliated institutions are traditional academies and public health bodies. The authors declare having no competing interests to disclose related to the submission of this manuscript and have not participated in and do not anticipate participation in any legal, regulatory, or advocacy proceedings related to the paper’s contents. This article has not received any external funding support.