Aspartate Aminotransferase Level as a Prognostic Marker in Acute Zinc Phosphide Poisoning

To identify whether hepatic enzyme levels can be used as a clinical predictor for mortality in patients presenting with acute zinc phosphide poisoning. A retrospective analysis of all acute zinc phosphide poisoning cases that had presented to our emergency medicine department within the past 5 years was performed. Statistical significance of the hepatic enzyme value to the outcome of poisoning was investigated. The average age of the cases was 23.6 years. Overall, 53.3% were females, and 35.5% of the total cases were married. A total of 75% patients developed bleeding manifestations and 53.3% had encephalopathy during the course. Overall, 64.4% patients had hypotension and required inotropic support. Renal failure was seen in 48.8% cases. Within 72 h, 60% cases had high anion gap non-compensated metabolic acidosis. An AST cut-off value of 1061 units/L was identified using an ROC curve, and its association to outcome was calculated and was shown to be significant (p=0.001). The mean ALT level for outcome was calculated and was found to be significant (p=0.001). The mean ALT value at mortality was 982.19±85.2 units/L. Absence of an antidote and rapid onset of MODS causes high mortality rate in acute zinc phosphide poisoning. From our study, we can suggest that in patients with hepatic involvement due to acute zinc phosphide poisoning, an AST value greater than 1061 units/L on the fifth day post-ingestion of the compound is an independent predictor for mortality.