Orhan GUMUS, Uğur DEMIR, Yavuz HEKIMOGLU, Erhan KARTAL, Yasin ETLI, Mahmut ASIRDIZER

A case who died due to the suicidal intake of aluminum phosphide

Alüminyum fosfit zehirlenmesi Türkiye ve gelişmiş ülkelerde nadir görülmesine rağmen yüksek ölüm oranı nedeniyle önemli bir sağlık sorunudur. "% 57 Fumiphos" ticari ad altında piyasaya sürülen, 3 g ağırlığındaki alüminyum fosfat tabletleri % 57 alüminyum fosfit ve % 43 amonyum karbonat içermektedir. Bu makalede, Türkiye'de nadir görülen bir alüminyum fosfit zehirlenmesi olgusunun klinik, olay yeri inceleme ve otopsi bulgularının tanımlanması ve olgumuzun verileri ile literatür bilgilerinin karşılaştırmalı olarak tartışılması amaçlanmıştır.20 yaşındaki erkek olgu, askerlik görevini yaparken, alüminyum fosfit alımını takiben ambulans ile hastaneye kaldırılmış ve yoğun kardiyo-pulmoner resusitasyon çabaları sonrası ex olarak kabul edilmişti. Tanık ifadelerinden, hastanın ağız yoluyla kutusunun üzerinde "Fumiphos 57% aluminum phosphide" yazan ve hastanın ceket cebinde bulunan bir zehir aldığı, sosyal medyada ölüm hakkında bazı ifadeler paylaştığı öğrenilmişti. Uygulanan adli otopside makroskobik bulgular tanımlanmış, otopside elde edilen doku örnekleri mikroskobik olarak incelenmişti. Otopside elde edilen örneklerin toksikolojik analiz sonuçlarında, mide içeriğinde 14184 ng/g alüminyum bulunduğu, iç organ ve kas örneklerinde p-tolüen sülfonik asit saptandığı rapor edilmişti.Otopside elde edilen makroskopik ve mikroskopik bulgular, literatürde tanımlanan non-spesifik bulgular ile uyumlu bulunmuştu. Suç mahalli, otopsi ve toksikolojik analiz bulgularının değerlendirilmesi sonucunda, kişinin ölümünün alüminyum fosfit zehirlenmesi nedeniyle meydana geldiğine karar verilmişti.Bu olgu sunumunda, zehirlenme şüphesi olan olgularda uygulanması gereken adli tıp prosedürüne dikkat çekilmiş, gelişmekte olan ülkelerde yaygın olarak görülen ancak Türkiye'de ve gelişmiş ülkelerde nadir görülen bir durum olan, alüminyum fosfit zehirlenmesinden ölen bir olgu sunulmuş ve alüminyum fosfit zehirlenmesine karşı alınacak önlemler tanımlanmıştır. Ayrıca klasik literatürde nadiren tanımlanmış olan mevcut olgunun makroskopik ve mikroskopik bulgularının adli tıp araştırmacılarına alüminyum fosfit zehirlenmesi için rehber olacağını düşünmekteyiz

Alüminyum fosfit'in intihar amaçlı alımına bağlı bir ölüm olgusu

Although it is rarely seen in Turkey and developed countries, aluminum phosphide poisoning is an important heath problem because of its high mortality rate. Aluminum phosphate tablets in 3 g weight which are sold in the market under the trade name "57% Fumiphos" include 57% aluminum phosphide and 43% ammonium carbonate. In the present report, it was aimed to define clinical, crime scene investigation and autopsy findings of a case of aluminum phosphide poisoning that was rarely seen in Turkey and comparatively discuss data of our case and literature knowledge. 20 years old male patient, hospitalized with an ambulance following intake of aluminum phosphide while he was in military service and he was accepted as exitus after intense cardio-pulmonary resuscitation efforts. From witness statements, it was learned that patient taken orally a poison; a pill box written "Fumiphos 57% aluminum phosphide" on it, was found in patient's jacket pocket; and it was learned that patient shared some words about death in social media before the event. In the performed medico-legal autopsy, macroscopic findings were defined and the tissue samples which obtained in autopsy were examined microscopically. In the results of toxicological analysis of samples which obtained in autopsy, it was reported the presence of 14184 ng/g aluminum in stomach contents and p-toluene sulfonic acid in visceral organ and muscle samples. Macroscopic and microscopic findings which obtained at autopsy was found compatible with non-specific findings which defined in the literature. In the result of evaluation of crime scene, autopsy and toxicological analysis findings, it was decided that the person's death occurred due to aluminum phosphide poisoning. In this case report, forensic-medicine procedures in cases died due to intoxications was emphasized, and a case who died due to aluminum phosphide poisoning that was a condition commonly seen in developing countries, but rarely seen in Turkey and developed countries was presented and precautions against aluminum phosphide poisoning were defined. Additionally, we suggest that macroscopic and microscopic autopsy findings of the present case which is rarely defined in classical literature will be a guide to medico-legal examiners for aluminum phosphide poisoning

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Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock 2011; 4: 378-84.
Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J 2006; 23: e3.
3. Address: https://en.wikipedia.org/wiki/Aluminium_ phosphate. Retrieved: July 14, 2016.
Mostafazadeh B. Aluminium Phosphide Poisoning. In: Acree W (ed). Toxicity and drug testing. 1st ed. Rijeka: InTech, 2012: pp 345-60.
Shadnia S, Soltaninejad K, Hassanian- Moghadam H, Sadeghi A, Rahimzadeh H, Zamani N, Ghasemi-Toussi A, Abdollahi M. Methemoglobinemia in aluminum phosphide poisoning. Hum Exp Toxicol 2011; 30: 250-3.
Anand R, Binukumar BK, Gill KD. Aluminum phosphide poisoning: an unsolved riddle. J Appl Toxicol 2011; 31: 499-505. 7. Address: http://www.agrifum.com/dosyalar/fumiph os_msds.pdf. Retrieved: July 14, 2016.
Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2012; 63: 61-73.
Jaiswal S, Verma RK, Tewari N. Aluminum phosphide poisoning: effect of correction of severe metabolic acidosis on patient outcome. Indian J Crit Care Med 2009; 13: 21-4.
Soltaninejad K, Nelson LS, Bahreini SA, Shadnia S. Fatal aluminum phosphide poisoning in Tehran-Iran from 2007 to 2010. Indian J Med Sci 2012; 66: 66-70.
Hakimoglu S, Dikey I, Sari A, Kekec L, Tuzcu K, Karcioglu M. Successful management of aluminum phosphide poisoning resulting in cardiac arrest. Turk J Anaesthesiol Reanim 2015; 43: 288-90.
Altintop I, Kaynak MF. A race against time in lethal aluminum phosphide intoxication: a case report. Medicine Science 2016; 5(Suppl 1): 143-5.
Singh UR, Tiwari S, Garg SP, Kuriakose L. A study of histopathological changes in viscera in aluminium phosphide poisoning. International Journal of Recent Advances in Multidisciplinary Research 2015; 2: 141-4.
Moghadamnia AA. An update on toxicology of aluminum phosphide. Daru. 2012; 20: 25.
Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol (Phila) 2009; 47: 89-100.
Ntelios D, Mandros C, Potolidis E, Fanourgiakis P. Aluminium phosphide- induced leukopenia. BMJ Case Rep. 2013; 2013. pii: bcr2013201229.
Anger F, Paysant F, Brousse F, Le Normand I, Develay P, Gaillard Y, Baert A, Le Gueut MA, Pepin G, Anger JP. Fatal aluminum phosphide poisoning. J Anal Toxicol 2000; 24: 90-2.
Guner U. Toxicology. Edirne: Trakya University Science Faculty, 2014.
Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: a review of literature. Forensic Sci Int 2012; 214: 1-6.
Address:https://pubchem.ncbi.nlm.nih.gov /compound/p- toluenesulfonic_acid#section=Top. Retrieved: July 14, 2016.
Jain AK, Nigam M, Garg SD, Dubey BP, Arora A. Aluminium phosphide poisoning, autopsy findings. JIAFM 2005: 27: 35-9.
Etemadi-Aleagha A, Akhgari M, Iravani FS. Aluminum phosphide poisoning- related deaths in Tehran, Iran, 2006 to 2013. Medicine (Baltimore) 2015; 94: e1637.
Krischer JP, Fine EG, Davis JH, Nagel EL. Complications of cardiac resuscitation. Chest 1987; 92: 287-91.
Chaudhary S, Momin SG, Vora DH, Modi P, Chauhan V, Chotaliya D.An epidemiological study of fatal aluminium phosphide poisoning at Rajkot. IOSR Journal of Pharmacy 2013; 3: 17-2.