Elsharkawy Rasha E, Ghonem Mona M, El-Sarnagawy Ghada N, Nagy Ayman A, Heshmat Mona M
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt.
Toxicol Res (Camb). 2023 May 27;12(3):507-519. doi: 10.1093/toxres/tfad037. eCollection 2023 Jun.
Aluminum phosphide (ALP)-induced cardiotoxicity is a major cause of high mortality rates. As there is no specific antidote, restoring cardiac hemodynamics is the cornerstone for saving patients. Based on oxidative stress theory in acute ALP poisoning, we examined the cardioprotective role of coconut oil and Coenzyme Q10 (COQ10) in ALP poisoning, focusing on their antioxidant capacity. This study was a randomized, controlled, single-blind, phase II clinical trial conducted at Tanta Poison Control Center over 1 year. Eighty-four ALP poisoned patients received supportive treatment and were randomly allocated to three equal groups. Gastric lavage was performed using sodium bicarbonate 8.4% with saline in group I. Alternatively, group II received 50 ml coconut oil, and group III initially received 600 mg CoQ10 dissolved in 50 ml coconut oil; and repeated 12 hours later. In addition to patient characteristics, clinical, laboratory, electrocardiography (ECG), and total antioxidant capacity (TAC) data were recorded and repeated 12 hours later. Patient outcomes were evaluated. There was no significant difference among groups considering patient characteristics, initial cardiotoxicity severity, vital, laboratory data, ECG changes, and TAC. However, 12 hours post-admissions, group III was significantly improved in all clinical, laboratory, and ECG parameters than comparable groups. Significant correlations were observed between elevated TAC in groups II and III with hemodynamic, serum troponin, and ECG variables. Accordingly, the need for intubation, mechanical ventilation, and the total vasopressor dose was significantly decreased in group III compared with other groups. Therefore, coconut oil and COQ10 are promising cardioprotective adjuvant therapy ameliorating the ALP-induced cardiotoxicity.
磷化铝（ALP）所致心脏毒性是高死亡率的主要原因。由于没有特效解毒剂，恢复心脏血流动力学是挽救患者的基石。基于急性ALP中毒的氧化应激理论，我们研究了椰子油和辅酶Q10（COQ10）在ALP中毒中的心脏保护作用，重点关注它们的抗氧化能力。本研究是在坦塔中毒控制中心进行的一项为期1年的随机、对照、单盲II期临床试验。84例ALP中毒患者接受支持治疗，并被随机分为三组，每组人数相等。第一组使用8.4%的碳酸氢钠与生理盐水进行洗胃。第二组给予50毫升椰子油，第三组最初给予溶解在50毫升椰子油中的600毫克COQ10，并在12小时后重复给药。除患者特征外，还记录了临床、实验室、心电图（ECG）和总抗氧化能力（TAC）数据，并在12小时后重复记录。评估患者的预后。在患者特征、初始心脏毒性严重程度、生命体征、实验室数据、ECG变化和TAC方面，各组之间没有显著差异。然而，入院12小时后，第三组在所有临床、实验室和ECG参数方面均比相应组有显著改善。第二组和第三组TAC升高与血流动力学、血清肌钙蛋白和ECG变量之间存在显著相关性。因此，与其他组相比，第三组插管、机械通气的需求以及血管升压药的总剂量显著降低。因此，椰子油和COQ10有望成为改善ALP所致心脏毒性的心脏保护辅助治疗药物。
