Myocardial InjuryNCT05370729
Impact of N-acetylcysteine Infusion and Intralipid Infusion on Myocardial Injury in Aluminum Phosphide Toxicity
A study testing N-acetyl cysteine in people with Myocardial Injury, run by Assiut University.
Trial summary
Assess impact of ILE and NAC in morbidity and mortality when used as adjuvant therapy to routine management of acute ALP poisoning. Read more about this study
- Who is it for?
- Ages 18 to 70 years
- Conditions the study is for
- Myocardial Injury
- What is being tested?
- N-acetyl cysteine
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 58 participants
- Where
- No sites listed yet
- Study dates
- May 2022to May 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 70 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Presentation with symptomatic acute ALP poisoning.
- History of exposure including reliable identification of the compound based on the container brought by patient's relatives.
- The suggestive clinical manifestations following shortly after a single exposure to ALP.
Who cannot join
- Co-ingestion or exposure to other substances in addition to ALP.
- Patients had major medical conditions (e.g., cardiovascular disease, renal or hepatic failure).
- Patients received treatment in any hospital or medical center before admission - other than emergency department of Assiut University Hospital.
Trial locations and contacts
No sites are listed yet.
About this study
Official title: Impact of Combining N-acetylcysteine Intravenous Infusion and Intralipid Emulsion Infusion Versus Intralipid Infusion Alone on Myocardial Injury in Aluminum Phosphide Toxicity
Assess impact of ILE and NAC in morbidity and mortality when used as adjuvant therapy to routine management of acute ALP poisoning.
Read the detailed description
Aluminum phosphide (ALP) is one of the solid fumigant pesticides. In Egypt, ALP is extensively used to protect grains against insects and rodents. It is available in the form of tablets known as "grain tablet". Suicidal ingestion of ALP tablets is obviously increasing in developing countries. This is attributed to its wide use, free availability in the market, and its low cost.
Aluminum phosphide toxicity is extremely fatal. The conveyed mortality rate differs from 37-100%. More than 90% of patients die within the first 24 hours, mainly due to cardiac dysrhythmia. Despite continuous research, no effective antidote has been reported for this lethal poisoning so far. PH3 is phosphorus trihydride and solubility of phosphorus can affect PH3. Solubilities of phosphorus are as follows: In water: 1 part/300,000 parts water; in absolute alcohol: 1 g/400 mL. One gram phosphorus dissolves in 80 ml olive oil, 60 ml oil of turpentine, and about 100 mL of almond oil. So, PH3 might also have lipid soluble property and used IV lipid emulsion may counter its effects.
Intravenous lipid emulsion (ILE) is a sterile fat emulsion prepared for intravenous administration as a source of calories and essential fatty acids. Its main components include up to 20% soybean oil, 1.2% egg yolk phospholipids, 2.25% glycerin, and water for injection. In addition, sodium hydroxide has been added to adjust the pH, so that the final pH is 8.
Based on animal models and clinical studies, ILE is an established antidote for local-anesthetic drugs systemic toxicity. Besides, ILE has been well used for resuscitation of severe toxicities caused by various lipophilic non-local anesthetic drugs.
N-acetylcysteine (NAC) is a well-studied compound which is commonly used in the treatment of paracetamol poisoning. It has shown to replenish cellular glutathione stores in addition to the strong antioxidant properties. NAC has shown to reduce mortality, hospitalization time, and need for mechanical ventilation in ALP poisoning. A cohort study by Agarwal reported survival benefit in patients who received treatment with NAC compared to the control group.
Brain natriuretic peptide (BNP) is an excellent biomarker because it can be detected in the early stages of ischemia and decreases shortly after ischemia allowing better detection of re-injury. A metabolite of BNP, Nterminal pro-BNP, NT-proBNP, is relatively easy to measure and predicts short and long term outcomes. BNP is a 32-amino-acid peptide synthesized predominantly from the ventricular myocardium and is released in proportion to the degree of wall stress. Although it has gained recent prominence in the diagnosis and treatment of heart failure, BNP has recently shown promise in predicting the extent of myocardial ischemia in acute coronary syndromes. For instance, the magnitude of BNP released between 1 and 7 days after a myocardial infarction is predictive of left ventricular dysfunction, heart failure, and mortality.
- Conditions
- Myocardial Injury
- Being tested
- N-acetyl cysteine
- Keywords
- Aluminum phosphide poisonings, Intralipid emulsion, N-acetylcystiene, Myocardial injury, Echocardiography
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
N-acetyl cysteineDrug
Also called NAC
Intravenous infusion of NAC 150 mg/kg body weight in 200 ml of 5% dextrose over 1 h, followed by 50 mg/kg body weight in 500 ml of 5% dextrose over 4 h, and then 100 mg/kg body weight in 1000 ml of 5% dextrose over 16 h.
| Study group | Role | What they receive |
|---|---|---|
| N-acetyl cysteine (NAC) | Experimental | Conservative management + ILE infusion 10 ml/hr + N-acetyl cysteine (NAC) infusion 150 mg/kg body weight in 200 ml of 5% dextrose over 1 h, followed by 50 mg/kg body weight in 500 ml of 5% dextrose over 4 h, and then 100 mg/kg body weight in 1000 ml of 5% dextrose over 16 h. Receives: Drug: N-acetyl cysteine |
| Intra lipid emulsion (ILE) | No intervention | Conservative management + ILE infusion 10 ml/hr + normal saline infusion |
What is being measured
The primary outcome is the main question the study is designed to answer.
Echocardiography
Follow up cardiac function by echocardiography focusing on LV EF
Measured: 24 hours
Secondary outcomes (2)
Renal function test
Effect on renal function by measuring serum creatinine and serum BUN
Measured: 24 hours
Total days of ICU stay
ICU stay
Measured: Up to two weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 May 2022
- Study startMay 2022 (estimated)
- Primary completionMay 2024 (estimated)
- Study completionMay 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Myocardial InjuryStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 58 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Tassbeeh Kamal, Assiut University
- Investigators
- Ola M Wahba, PHD, MD, Study director, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05370729
- Sponsor's protocol ID
- NACILEALP
- Status last verified
- May 2022
- First submitted
- 21 Mar 2022
- Last updated
- 11 May 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Baruah U, Sahni A, Sachdeva HC. Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: Report of two cases. Indian J Crit Care Med. 2015 Dec;19(12):735-8. doi: 10.4103/0972-5229.171412.
PubMed 26816450Tehrani 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 Jan;51(1):23-8. doi: 10.3109/15563650.2012.743029. Epub 2012 Nov 14.
PubMed 23148565Agarwal 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 Oct;18(10):666-71. doi: 10.4103/0972-5229.142176.
PubMed 25316977Tsutamoto T, Wada A, Maeda K, Hisanaga T, Maeda Y, Fukai D, Ohnishi M, Sugimoto Y, Kinoshita M. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation. 1997 Jul 15;96(2):509-16. doi: 10.1161/01.cir.96.2.509.
PubMed 9244219
Study at a glance
From the registry record, last updated by the sponsor on 11 May 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact of Combining N-acetylcysteine Intravenous Infusion and Intralipid Emulsion Infusion Versus Intralipid Infusion Alone on Myocardial Injury in Aluminum Phosphide Toxicity
- ClinicalTrials.gov ID
- NCT05370729
- Acronym / sponsor ID
- NACILEALP
- Conditions
- Myocardial Injury
- Keywords
- Aluminum phosphide poisonings, Intralipid emulsion, N-acetylcystiene, Myocardial injury, Echocardiography
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 58 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- May 2022 (estimated)
- Primary completion
- May 2024 (estimated)
- Study completion
- May 2025 (estimated)
- First posted
- 11 May 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Assess impact of ILE and NAC in morbidity and mortality when used as adjuvant therapy to routine management of acute ALP poisoning.
Detailed description
Aluminum phosphide (ALP) is one of the solid fumigant pesticides. In Egypt, ALP is extensively used to protect grains against insects and rodents. It is available in the form of tablets known as "grain tablet". Suicidal ingestion of ALP tablets is obviously increasing in developing countries. This is attributed to its wide use, free availability in the market, and its low cost.
Aluminum phosphide toxicity is extremely fatal. The conveyed mortality rate differs from 37-100%. More than 90% of patients die within the first 24 hours, mainly due to cardiac dysrhythmia. Despite continuous research, no effective antidote has been reported for this lethal poisoning so far. PH3 is phosphorus trihydride and solubility of phosphorus can affect PH3. Solubilities of phosphorus are as follows: In water: 1 part/300,000 parts water; in absolute alcohol: 1 g/400 mL. One gram phosphorus dissolves in 80 ml olive oil, 60 ml oil of turpentine, and about 100 mL of almond oil. So, PH3 might also have lipid soluble property and used IV lipid emulsion may counter its effects.
Intravenous lipid emulsion (ILE) is a sterile fat emulsion prepared for intravenous administration as a source of calories and essential fatty acids. Its main components include up to 20% soybean oil, 1.2% egg yolk phospholipids, 2.25% glycerin, and water for injection. In addition, sodium hydroxide has been added to adjust the pH, so that the final pH is 8.
Based on animal models and clinical studies, ILE is an established antidote for local-anesthetic drugs systemic toxicity. Besides, ILE has been well used for resuscitation of severe toxicities caused by various lipophilic non-local anesthetic drugs.
N-acetylcysteine (NAC) is a well-studied compound which is commonly used in the treatment of paracetamol poisoning. It has shown to replenish cellular glutathione stores in addition to the strong antioxidant properties. NAC has shown to reduce mortality, hospitalization time, and need for mechanical ventilation in ALP poisoning. A cohort study by Agarwal reported survival benefit in patients who received treatment with NAC compared to the control group.
Brain natriuretic peptide (BNP) is an excellent biomarker because it can be detected in the early stages of ischemia and decreases shortly after ischemia allowing better detection of re-injury. A metabolite of BNP, Nterminal pro-BNP, NT-proBNP, is relatively easy to measure and predicts short and long term outcomes. BNP is a 32-amino-acid peptide synthesized predominantly from the ventricular myocardium and is released in proportion to the degree of wall stress. Although it has gained recent prominence in the diagnosis and treatment of heart failure, BNP has recently shown promise in predicting the extent of myocardial ischemia in acute coronary syndromes. For instance, the magnitude of BNP released between 1 and 7 days after a myocardial infarction is predictive of left ventricular dysfunction, heart failure, and mortality.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| N-acetyl cysteine (NAC) | Experimental | Drug: N-acetyl cysteineConservative management + ILE infusion 10 ml/hr + N-acetyl cysteine (NAC) infusion 150 mg/kg body weight in 200 ml of 5% dextrose over 1 h, followed by 50 mg/kg body weight in 500 ml of 5% dextrose over 4 h, and then 100 mg/kg body weight in 1000 ml of 5% dextrose over 16 h. |
| Intra lipid emulsion (ILE) | No intervention | –Conservative management + ILE infusion 10 ml/hr + normal saline infusion |
Who may qualify
- Ages
- 18 to 70 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Presentation with symptomatic acute ALP poisoning.
- History of exposure including reliable identification of the compound based on the container brought by patient's relatives.
- The suggestive clinical manifestations following shortly after a single exposure to ALP.
Key exclusion criteria (3 listed)
- Co-ingestion or exposure to other substances in addition to ALP.
- Patients had major medical conditions (e.g., cardiovascular disease, renal or hepatic failure).
- Patients received treatment in any hospital or medical center before admission - other than emergency department of Assiut University Hospital.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| N-acetyl cysteineAlso: NACIntravenous infusion of NAC 150 mg/kg body weight in 200 ml of 5% dextrose over 1 h, followed by 50 mg/kg body weight in 500 ml of 5% dextrose over 4 h, and then 100 mg/kg body weight in 1000 ml of 5% dextrose over 16 h. | Drug | N-acetyl cysteine (NAC) |
Primary outcome
Echocardiography
Time frame: 24 hours
Follow up cardiac function by echocardiography focusing on LV EF
2 secondary outcomes
Renal function test
Time frame: 24 hours
Total days of ICU stay
Time frame: Up to two weeks
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 May 2022.
- Background: PubMed 26816450Baruah U, Sahni A, Sachdeva HC. Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: Report of two cases. Indian J Crit Care Med. 2015 Dec;19(12):735-8. doi: 10.4103/0972-5229.171412.
- Background: PubMed 23148565Tehrani 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 Jan;51(1):23-8. doi: 10.3109/15563650.2012.743029. Epub 2012 Nov 14.
- Background: PubMed 25316977Agarwal 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 Oct;18(10):666-71. doi: 10.4103/0972-5229.142176.
- Background: PubMed 9244219Tsutamoto T, Wada A, Maeda K, Hisanaga T, Maeda Y, Fukai D, Ohnishi M, Sugimoto Y, Kinoshita M. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation. 1997 Jul 15;96(2):509-16. doi: 10.1161/01.cir.96.2.509.
- Individual participant dataSharing planned: No
Related trials for Myocardial Injury
Not yet recruitingPhase 4
Roxadustat and Myocardial Injury After Off-Pump Coronary Artery Bypass Surgery
Coronary Artery Disease, Coronary Artery Bypass Grafting
RecruitingPhase 2
Prevention of Reperfusion Injury Outcomes Through Effective Cardioprotection Targeting Myocardial Infarction
Myocardial Infarction, Reperfusion Injury
Not yet recruitingObservational study
PAtient Similarity for Decision-Making in Prevention of Cardiovascular Toxicity (PACT): A Feasibility Study
Heart Failure, Coronary Artery Disease
Not yet recruitingPhase 2
Evaluating SGLT2 Inhibitors for the Reduction of No-Reflow Phenomenon in Patients Undergoing PCI
No Reflow Phenomenon, Reperfusion Injuries, Myocardial
RecruitingObservational study
Mechanisms of Myocardial Injury and Ischemia in Patients With Rapid Atrial Fibrillation
Atrial Fibrillation (AF)
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Ola M Wahba, PHD, MD study director
Assiut University
Questions about this trial
What is this clinical trial studying?
A study testing N-acetyl cysteine in people with Myocardial Injury, run by Assiut University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 11 May 2022. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Tassbeeh Kamal (01065656202, tk.zanaty_92@med.aun.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Echocardiography (time frame: 24 hours). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05370729, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 May 2022.