Login Register Cart 0
Generic placeholder image

Current Reviews in Clinical and Experimental Pharmacology

Editor-in-Chief

ISSN (Print): 2772-4328
ISSN (Online): 2772-4336

Back
Journal Home About Journal Editorial Board Current Issue Volumes/Issues
Subscribe
Systematic Review Article

N-Acetyl Cysteine in Rodenticide Poisoning: A Systematic Review and Meta-Analysis

Author(s): Muhammed Rashid, Viji Pulikkel Chandran, Sreedharan Nair, Deepa Sudalai Muthu, Jemima Pappuraj, Krupa Ann Jacob, Balaji Sridhar, Karen Mark , Shabnam Hyder, Sohil Khan and Girish Thunga*

Volume 17, Issue 3, 2022

Published on: 25 August, 2021

Page: [192 - 204] Pages: 13

DOI: 10.2174/2772432816666210825102726

Price: $65

Abstract

Background: Treatment with N-Acetyl Cysteine (NAC) in rodenticide poisoning has not been well established due to mixed study results and insufficient evidence. This review aimed to summarize the clinical benefits of NAC in the management of rodenticide poisoning.

Methods: This review follows the PICOS framework and the PRISMA guidelines. Pub- Med/MEDLINE, Scopus, and the Cochrane library were searched to identify the published literature from inception to September 2020, and a reference search was performed for additional relevant studies. The English language studies addressing the use of NAC in rodenticide poisoning were considered for the review. We considered all experimental and observational studies due to the insufficient number of interventional studies.

Results: Ten studies (two RCTs, four observational, and four descriptive) out of 2,178 studies with 492 participants were considered for the review. Only six studies (two RCTs, one prospective, and three retrospective studies) reported recovery and mortality. Pooled results of RCTs (n=2) showed a significant recovery rate (Odds Ratio [OR]: 3.97; 95% Confidence Interval [CI]:1.69-9.30), whereas summary estimates of prospective and retrospective studies recorded a non-significant effect. Metaanalysis of RCTs (OR: 0.25; 95% CI: 0.11-0.59; n=2) and retrospective studies (OR: 0.34; 95% CI: 0.15-0.78; n=3) showed a significant reduction in mortality, whereas pooled analysis of prospective studies recorded a non-significant effect. A significant reduction in intubation or ventilation (OR: 0.25; 95% CI: 0.11-0.60; 2 RCTs) and a non-significant (P=0.41) difference in duration of hospitalization was observed with NAC when compared to the non-NAC treated group. The quality of the included studies appeared to be moderate to high.

Conclusion: Our findings indicate that NAC showed better survival and lower mortality rate when compared to non-NAC treated group; hence NAC can be considered for the management of rodenticide poisoning.

Keywords: Efficacy, poison, rat poison, safety, yellow phosphorous, zinc phosphide.

« Previous Next »
Graphical Abstract

[1]
Mohideen SK, Kumar KS. Should ratol paste be banned? Indian J Crit Care Med 2015; 19(2): 128-9.
[http://dx.doi.org/10.4103/0972-5229.151026] [PMID: 25722560]
[2]
Bhat S, Kenchetty KP. N-acetyl cysteine in the management of rodenticide consumption - life saving? J Clin Diagn Res 2015; 9(1): OC10-3.
[http://dx.doi.org/10.7860/JCDR/2015/11484.5455] [PMID: 25738016]
[3]
Debbarma M, Dasgupta A. Yellow phosphorus induced acute fulminant liver failure. Assam J Intern Med 2017; 7(1): 47-8.
[4]
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Osterthaler KM, Banner W. 2017 annual report of the American association of poison control centers’ National Poison Data System (NPDS): 35th annual report. Clin Toxicol (Phila) 2018; 56(12): 1213-415.
[http://dx.doi.org/10.1080/15563650.2018.1533727] [PMID: 30576252]
[5]
Saraf V, Pande S, Gopalakrishnan U, et al. Acute liver failure due to zinc phosphide containing rodenticide poisoning: Clinical features and prognostic indicators of need for liver transplantation. Indian J Gastroenterol 2015; 34(4): 325-9.
[http://dx.doi.org/10.1007/s12664-015-0583-2] [PMID: 26310868]
[6]
D’Silva C, Krishna B. Rodenticide Poisoning. Indian J Crit Care Med 2019; 23(Suppl. 4): S272-7.
[http://dx.doi.org/10.5005/jp-journals-10071-23318] [PMID: 32021003]
[7]
Santus P, Corsico A, Solidoro P, Braido F, Di Marco F, Scichilone N. Oxidative stress and respiratory system: pharmacological and clinical reappraisal of N-acetylcysteine. COPD 2014; 11(6): 705-17.
[http://dx.doi.org/10.3109/15412555.2014.898040] [PMID: 24787454]
[8]
Dekhuijzen PNR. Antioxidant properties of N-acetylcysteine: their relevance in relation to chronic obstructive pulmonary disease. Eur Respir J 2004; 23(4): 629-36.
[http://dx.doi.org/10.1183/09031936.04.00016804] [PMID: 15083766]
[9]
Mokhtari V, Afsharian P, Shahhoseini M, Kalantar SM, Moini A. A Review on various uses of N-Acetyl cysteine. Cell J 2017; 19(1): 11-7.
[PMID: 28367412]
[10]
Thunga G, Muthu DS, Pappuraj J, et al. Role of N-acetyl cysteine in rodenticide poisoning: A systematic review and meta-analysis. CRD42020154376 2020. Available from: https://www.crd.york. ac.uk/prospero/display_record.php?ID=CRD42020154376
[11]
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.
[http://dx.doi.org/10.1136/bmj.b2535] [PMID: 19622551]
[12]
Howick J, Chalmers I, Glasziou P. The oxford 2011 levels of evidence Oxford, UK: Oxford Centre for evidence-based medicine. 2011.
[13]
Higgins JP, Green S, Eds. Eds. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons 2011. Available from: www.handbook.cochrane.org
[14]
Sterne JA, Higgins JP, Elbers RG, Reeves BC. Risk of bias in nonrandomised studies of interventions (ROBINS-I). Detailed guidance 2016. Available from: https://methods.cochrane.org/bias/risk-bias-non-randomized-studies-interventions
[15]
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018; 23(2): 60-3.
[http://dx.doi.org/10.1136/bmjebm-2017-110853] [PMID: 29420178]
[16]
Rashid M, Rajan AK, Chhabra M, Kashyap A. Levetiracetam and cutaneous adverse reactions: A systematic review of descriptive studies. Seizure 2020; 75: 101-9.
[http://dx.doi.org/10.1016/j.seizure.2020.01.002] [PMID: 31931437]
[17]
Rashid M, Kashyap A, Undela K. Valproic acid and Stevens-Johnson syndrome: A systematic review of descriptive studies. Int J Dermatol 2019; 58(9): 1014-22.
[http://dx.doi.org/10.1111/ijd.14411] [PMID: 30809807]
[18]
Kashyap A, Sreenivasan S, Rajan AK, Rashid M, Chhabra M. Ciprofloxacin-induced cutaneous adverse drug events: A systematic review of descriptive studies. J Basic Clin Physiol Pharmacol 2021; 16.
[http://dx.doi.org/10.1515/jbcpp-2020-0115] [PMID: 33725760]
[19]
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(1): 23-8.
[http://dx.doi.org/10.3109/15563650.2012.743029] [PMID: 23148565]
[20]
Tawfik HM. Study of the role of N-acetyl cysteine in phosphide poisoning. J Clin Toxicol 2019; 9(412): 2.
[21]
Agarwal A, Robo R, Jain N, Gutch M, Consil S, Kumar S. Oxidative stress determined through the levels of antioxidant enzymes and the effect of N-acetylcysteine in aluminum phosphide poisoning. Indian J Crit Care Med 2014; 18(10): 666-71.
[http://dx.doi.org/10.4103/0972-5229.142176] [PMID: 25316977]
[22]
Fernandez OU, Canizares LL. Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks. J Clin Gastroenterol 1995; 21(2): 139-42.
[http://dx.doi.org/10.1097/00004836-199509000-00015] [PMID: 8583080]
[23]
Mark K, Hyder S, Rashid M, et al. Survival benefits of N-Acetylcysteine in rodenticide poisoning: Retrospective evidence from an Indian tertiary care setting. Curr Clin Pharmacol 2020; 12.
[http://dx.doi.org/10.2174/1574884715666200513090634] [PMID: 32400335]
[24]
Oghabian Z, Afshar A, Rahimi HR. Hepatotoxicity due to zinc phosphide poisoning in two patients: role of N-acetylcysteine. Clin Case Rep 2016; 4(8): 768-72.
[http://dx.doi.org/10.1002/ccr3.618] [PMID: 27525081]
[25]
Manouchehri A, Ahangar RM, Bigvand P, Nakhaee S, Mehrpour O. Successful treatment of heart failure due to simultaneous poisoning with aluminum phosphide and zinc phosphide: A case report. Iran Red Crescent Med J 2019; 21(3)e57123
[26]
Çakın Ö, Tazegul G, Gümüş A, Cengiz M, Ramazanoğlu A. Incidental aluminum phosphide poisoning: Case report and current management. Folia Med (Plovdiv) 2018; 60(3): 464-7.
[http://dx.doi.org/10.2478/folmed-2018-0001] [PMID: 30355847]
[27]
Kharkongor MA, Mishra AK, Ninan KF, Iyadurai R. Early use of intravenous N-acetylcysteine in treatment of acute yellow phosphorus poisoning. Current Medical Issues 2017; 15(2): 136.
[http://dx.doi.org/10.4103/0973-4651.206530]
[28]
Ma M, Zhang M, Tang X, Li Z. Massive neonatal intracranial hemorrhage caused by bromadiolone: A case report. Medicine (Baltimore) 2017; 96(45)e8506
[http://dx.doi.org/10.1097/MD.0000000000008506] [PMID: 29137047]
[29]
Mehlhaff KM, Baxter CC, Rudinsky K, McKenna DS. Lethal neonatal coagulopathy after maternal ingestion of a superwarfarin. Obstet Gynecol 2013; 122(2 Pt 2): 500-2.
[http://dx.doi.org/10.1097/AOG.0b013e31829267c4] [PMID: 23884275]
[30]
Altay S, Cakmak HA, Boz GC, Koca S, Velibey Y. Prolonged coagulopathy related to coumarin rodenticide in a young patient: superwarfarin poisoning. Cardiovasc J S Afr 2012; 23(9): e9-e11.
[http://dx.doi.org/10.5830/CVJA-2012-051] [PMID: 23108575]
[31]
Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: A review of literature. Forensic Sci Int 2012; 214(1-3): 1-6.
[http://dx.doi.org/10.1016/j.forsciint.2011.06.018] [PMID: 21763089]
[32]
Chen XH, Dai BT, Yu J, et al. Analysis of thirteen cases with secondary coagulation disorder caused by raticide exposure. Zhonghua Er Ke Za Zhi 2010; 48(8): 629-32.
[PMID: 21055312]
[33]
Zhao SL, Li P, Ji M, Zong Y, Zhang ST. Upper gastrointestinal hemorrhage caused by superwarfarin poisoning. World J Gastroenterol 2010; 16(13): 1680-2.
[http://dx.doi.org/10.3748/wjg.v16.i13.1680] [PMID: 20355251]
[34]
Singh S, Singh D, Wig N, Jit I, Sharma BK. Aluminum phosphide ingestion--a clinico-pathologic study. J Toxicol Clin Toxicol 1996; 34(6): 703-6.
[http://dx.doi.org/10.3109/15563659609013832] [PMID: 8941200]
[35]
Misra UK, Tripathi AK, Pandey R, Bhargwa B. Acute phosphine poisoning following ingestion of aluminium phosphide. Hum Toxicol 1988; 7(4): 343-5.
[http://dx.doi.org/10.1177/096032718800700408] [PMID: 3410483]
[36]
Yamane M, Ohno T, Ohoka S, et al. Prompt treatment with peroral acetylcysteine for acute yellow phosphorus-induced liver injury: A recovered case. Ingastroenterology 1996; 110(4): A1364-4.
[37]
Karimani A, Mohammadpour AH, Zirak MR, et al. Antidotes for aluminum phosphide poisoning - An update. Toxicol Rep 2018; 5: 1053-9.
[http://dx.doi.org/10.1016/j.toxrep.2018.10.009] [PMID: 30406022]
[38]
Chaudhry D, Rai AS. N-acetyl cysteine in aluminum phosphide poisoning: Myth or hope. Indian J Crit Care Med 2014; 18(10): 646-7.
[http://dx.doi.org/10.4103/0972-5229.142172] [PMID: 25316973]
[39]
Ravikanth R, Sandeep S, Philip B. Acute yellow phosphorus poisoning causing fulminant hepatic failure with parenchymal hemorrhages and contained duodenal perforation. Indian J Crit Care Med 2017; 21(4): 238-42.
[http://dx.doi.org/10.4103/ijccm.IJCCM_410_16] [PMID: 28515612]
[40]
Mumtaz K, Azam Z, Hamid S, et al. Role of N-acetylcysteine in adults with non-acetaminophen-induced acute liver failure in a center without the facility of liver transplantation. Hepatol Int 2009; 3(4): 563-70.
[http://dx.doi.org/10.1007/s12072-009-9151-0] [PMID: 19727985]
[41]
Kortsalioudaki C, Taylor RM, Cheeseman P, Bansal S, Mieli-Vergani G, Dhawan A. Safety and efficacy of N-acetylcysteine in children with non-acetaminophen-induced acute liver failure. Liver Transpl 2008; 14(1): 25-30.
[http://dx.doi.org/10.1002/lt.21246] [PMID: 18161828]

Rights & Permissions Print Cite
Article Metrics
58
1
© 2024 Bentham Science Publishers | Privacy Policy