الفهرس 
Acknowledgement
Physicochemical propertiesOnly 14 pages are availabe for public view
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Abstract
Aluminum phosphide poisoning is a real and increasing threat, especially within cultural groups that have used this product for years as here in our governorate. It used as pesticides for many years to protect grains in stores and during its transportation. The availability of these tablets and their low cost make it an easy and common method of suicide in our country with the increasing incidence of social and financial problems that faces the youth. It is known in our society as ”wheat pills” or ”pest pills”. Aluminium phosphide is a common and fatal problem in our country. It’s a cardiotoxic agent and death usually due to cardiovasular failure. Clinical picture is non-specific and diagnosis based mainly on history. It is associated with high mortality rate reaching about 100%. ALP poisoning affects mainly middle aged persons who are an important part of the society. Management of aluminium phosphide poisoning is really a challenge due to absence of effective antidote till now and so strict supportive measures and maintaining adequate circulation and renal perfusion till excretion of the drug is the only way of getting over of this toxic phosphine and also, early start of the treatment which need education of population about the fatality of these tablets. Preventive measures as restrictions on its supply in the open market are also important and shop keepers should not sell the tablets to young people and children without proper verification and confirmation. This study is divided into two parts:- 1 Retrospective study during period from 1st January 2015 to 31th December 2015. It was found that 70 patients admitted to emergency unit of Assiut university hospital who were diagnosed as aluminium phosphide poisoning. There was middle aged male predominance especially in the summer months. The available data in the archive of the emergency unit was so deficient due to lack of recording. 2 Prospective study from 1st January 2016 to 30th June 2016. It was found that 44 patients admitted to emergency unit of Assiut University hospital with acute manifestations of toxicity and history of ALP exposure with different doses and conditions of the tablets. Male outnumbered females and middle aged persons were the main victims. The main presenting symptom was vomiting following exposure by 1 - 2 hours. On examination more than 50% of the patients were conscious with GCS more than 13, but about 45% were shocked at presentation that needed I.V. fluids ± inotropic drugs like dopamine infusion. Investigations were done for every patient including CBC, ABG, electrolytes (Na, K, and Mg), blood glucose, liver functions, renal functions, ECG, chest x-ray and ECHO. Relations between these parameter and prognosis were studied and showed that low PH, ECG abnormalities, deteriorated renal and liver functions are a bad prognostic factors. Treatment done included initial resuscitation with fluids and oxygen followed by decreasing absorption of poison using gastric lavage with potassium permanganate and sodium bicarbonate then leaving activated charcoal in the stomach. Cardiogenic shock needed cardiac support with dopamine and epinephrine and CVP guided fluids infusion. N- acetyl cysteine was given to patients and showed that it has a protective effect. Mortality rate was 45.5% and the cause of death was cardiac either due to arrhythmia or cardiac failure. In conclusion, ALP poisoning need more attention as it is a fatal toxin and till now there is no antidote. Last few years showed increasing in the victims among youth as a suicidal agent. Supportive measures are so vital in these patients and N-acetyl cysteine has a protective effect. There is an increasing need for better knowledge of these dangers with a highlighting on recognition, management and prevention. The fast progression to life-threatening symptoms, ineffective therapeutic means to solve its intoxication and limited data on the efficacy of therapeutic interventions pose challenges to the clinicians and emergency staffs.