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Indian J Crit Care Med. 2017 August; 21(8): 539–540.
PMCID: PMC5588494

Does N-acetyl Cysteine Have Protective Effects in Acute Aluminum Phosphide Poisoning?


Recently, an article by Farahani et al.[1] was published in Indian Journal of Critical Care Medicine. Aluminum phosphide (AlP) poisoning is common in Iran, and we have been involved in the clinical management of the poisoned patients. We have thus read this review article with interest and would like to mention the following points.

AlP is a highly toxic fumigant, which is unfortunately easily available in Iran and some other developing countries and has no effective antidote.[2] It seems that the main cause of mortality in AlP poisoning is cardiogenic shock due to toxic myocarditis.[3,4] Moreover, previously approved that deleterious effect of AlP on heart can be attributed to oxidative stress. Thus, it seems that antioxidant therapy by N-acetyl cysteine (NAC) may have an effective role in AlP-induced toxicity.[2,3]

The authors stated that “there is only one case report that showed administration of NAC as one component of a complex treatment could not save a patient.” In the literature review, we have found several case–control studies which showed NAC reduced cardiotoxicity of AlP. Taghaddosinejad et al. revealed that NAC has effect on some cardiac variables and reduce the mortality rate of AlP-induced toxicity.[3] In addition, Tehrani et al. in a prospective, randomized, controlled open-label trial found that NAC may have therapeutic effects in acute AlP poisoning and it can decrease the rates of intubation, ventilation, mortality, and duration of hospitalization.[2] Moreover, in another case report by Oghabian and Mehrpour, NAC successfully used as an antioxidant agent in addition to other treatments for AlP poisoning.[5] Another study by Agarwal et al. showed that the survival rate increased in patients receiving NAC along with supportive therapy.[6] In this regard, other researchers also suggested the use of NAC for treating AlP poisoning.[4] It seems that the administration of NAC in acute AlP poisoning should be considered.

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Conflicts of interest

There are no conflicts of interest.


1. Farahani MV, Soroosh D, Marashi SM. Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An evidence-based review. Indian J Crit Care Med. 2016;20:724–30. [PMC free article] [PubMed]
2. Tehrani H, Halvaie Z, Shadnia S, Soltaninejad K, Abdollahi M. Protective effects of N-acetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning. Clin Toxicol (Phila) 2013;51:23–8. [PubMed]
3. Taghaddosinejad F, Farzaneh E, Ghazanfari-Nasrabad M, Eizadi-Mood N, Hajihosseini M, Mehrpour O, et al. The effect of N-acetyl cysteine (NAC) on aluminum phosphide poisoning inducing cardiovascular toxicity: A case-control study. Springerplus. 2016;5:1948. [PMC free article] [PubMed]
4. Chaudhry D, Rai AS. N-acetyl cysteine in aluminum phosphide poisoning: Myth or hope. Indian J Crit Care Med. 2014;18:646–7. [PMC free article] [PubMed]
5. Oghabian Z, Mehrpour O. Treatment of aluminium phosphide poisoning with a combination of intravenous glucagon, digoxin and antioxidant agents. Sultan Qaboos Univ Med J. 2016;16:e352–5. [PMC free article] [PubMed]
6. Agarwal A, Robo R, Jain N, Gutch N, Consil S, Kumar S. Oxidative stress determined through the levels of antioxidant enzymes and the effect of N-acetyl cysteine in aluminum phosphide poisoning. Indian J Crit Care Med. 2014;18:668–73. [PMC free article] [PubMed]

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