N-acetylcysteine Use in Treatment of Acute Aluminium Phosphide Poisoning: Systematic Review and Meta-Analysis

Document Type : Original Article


1 Al khazendarah general hospital, Cairo, Egypt.

2 Department of Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Ain Shams University, Egypt.

3 Department of forensic medicine and clinical toxicology, Faculty of Medicine, Suez Canal University. Egypt.


Background: Aluminum phosphide (AlP) is a popular used rodenticide. It inhibits oxidative
phosphorylation, and causes depletion of glutathione, resulting in cellular wall dysfunction. Nacetylcysteine (NAC) is a glutathione precursor that would be effective in treatment of AlP
poisoning. Aim of the work: Provide evidence based systematic review about role of NAC in
treatment of AlP poisoning which may help in developing clear guidelines for treatment of such
lethal poisoning. Methodology: We followed PRISMA guidelines during preparation of this
study. PubMed, EKB, ScienceDirect and Cochrane CENTRAL were searched to identify the
published literature from inception to June 2022. In addition, we searched for ongoing studies,
reference lists for additional studies. We included randomized cotrolled trials (RCTs) and
observational studies (OSs) published in English, those fulfilling inclusion criteria. Results : The
study included four RCTs and two OSs with total 286 participants. The current study revealed
that there was a significant reduction in mortality rate (OR 0.38, 95% CI [0,23 to 0.66]) and
duration of hospital stay in survivors (SMD -1.73 days, 95% CI [-2.35, -01.11]) as well as a
significant increase in survival time in non survivors in patients who received NAC, compared
with those who did not receive NAC (SMD 0.87 day, 95% CI [0.37, 1.37]). There was no
significant difference between NAC and control groups regarding the need for mechanical
ventilation (OR 0.51, 95% CI [0,23 to 1.10]). Conclusion: N-acetylcysteine in treatment of
acute AlP poisoning can reduce the mortality rate and duration of hospital stay in survivors and
increase survival time.
Received in original form: 28 March 2023 Accepted in a final form: 16 July 2023