A review of aluminium phosphide poisoning and a flowchart to treat it

Abstract

The use of pesticides such as aluminium phosphide (AlP) has increased in the recent years and improved the quantity and quality of agricultural products in a number of developing countries. The downside is that AlP causes severe chronic and acute health effects that have reached major proportions in countries such as India, Iran, Bangladesh, and Jordan. Nearly 300,000 people die due to pesticide poisoning in the world every year. Poisoning with AlP accounts for many of these deaths. Unfortunately, at the same time, there is no standard treatment for it. The aim of this article is to give a brief review of AlP poisoning and propose a treatment flowchart based on the knowledge gained so far. For this purpose we reviewed all articles on the management of AlP poisoning published from 2000 till now. Using a modified Delphi design, we have designed a handy flowchart that could be used as a guide for AlP poisoning management of patients in emergency centres.

Study of laboratory profile in patients with aluminium phosphide poisoning in the southwest of Iran from 2010 to 2015

“…So in the face of aluminium phosphide poisoning, fast referral to the medical center, lack of washing the stomach with serum and the use of paraffin instead, quick analysis of arterial blood gas, electrolyte laboratory tests, electrocardiography and actions such as antacid prescription are the main measures to follow. Although, as can be seen in the review article published by Hashemi-Domeneh et al [23] poisoning with aluminium phosphide accounts for many of these deaths unfortunately, at the same time, there is no standard treatment for it and this problem requires more research on subject of treatment.…”

“…Zgodnie z pracą przeglądową autorstwa Hashemi-Domeneh i wsp. [23] zatrucie fosforkiem glinu wiąże się z wysoką śmiertelnością, a jednocześnie nie ma uznanego standardowego leczenia. Zagadnienie terapii wymaga bardziej kompleksowych badań.…”

Regional Medicine News

“…There is no definitive treatment or antidote, and treatment is largely supportive. 2 Other small epidemics like the one in Amarillo have been reported in the medical literature. Dadpour reported an epidemic of aluminum phosphide poisoning in 36 tourists staying in a hotel in Iran.…”

“…Phosphine gas is released when a phosphide comes into contact with moisture or acid. 2 This gas is toxic and potentially flammable and has an odor of decaying fish or garlic. Phosphine inhibits cytochrome C oxidase and causes oxidative stress followed by severe mitochondrial dysfunction, impaired cellular respiration, tissue hypoxia, and eventually multiorgan failure.…”

Gastric decontamination in aluminium phosphide poisoning: a case against the use of water-based solutions

“…Dear Editor-in-Chief, We read with great interest the article entitled "A review of aluminium phosphide poisoning and a flowchart to treat it" written by Hashemi-Domeneh et al (1) and recently published in the Archives of Industrial Hygiene and Toxicology. The authors mentioned performing a gastric lavage using a solution of potassium permanganate (1/10000/1 g per 10 L) and administering activated charcoal (1 g kg -1 in children and 50-100 g in adults) and sodium bicarbonate (two 44 meq vials [100 mL] per L) as options for gastrointestinal decontamination, claiming that these compounds can be effective at decreasing toxic phosphine (PH 3 ) production.…”