Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote

Abstract

Aluminum phosphide (ALP) poisoning is one of the major causes of suicidal deaths. Toxicity by ALP is caused by the liberation of phosphine gas, which rapidly causes cell hypoxia due to inhibition of oxidative phosphorylation, leading to circulatory failure. Treatment of ALP toxicity is mainly supportive as there is no specific antidote. We recently managed 7 cases of ALP poisoning with severe hemodynamic effects. Patients were treated with supportive measures including gastric lavage with diluted potassium permanganate, coconut oil and sodium-bicarbonate first person account should be avoided in a scientific paper. Intravenous magnesium sulfate, proper hemodynamic monitoring and vasopressors. Four out of 7 survived thus suggesting a role of such supportive measures in the absence of specific antidote for ALP poisoning.

Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: Report of two cases

“…[ 19 ] Rationale behind use of soda bicarbonate for moderate to severe acidosis is based on many studies mentioning it as a prognostic indicator of aluminum phosphide poisoning. [ 20 ] Moreover, drug ionization in acidic environment may reduce lipophilicity preventing maximal potential sequestration to circulating lipid particle. [ 21 ] However, there is literature against the use of sodium bicarbonate to treat metabolic acidosis in ALP poisoning.…”

Can sodium bicarbonate really help in treating metabolic acidosis caused by aluminium phosphide poisoning?

“…Management of aluminium phosphide (AlP) poisoning seems to have seen some changes over the recent years (1). We believe that one of the reasons was the review article (2) and letters to the editor (3)(4)(5) published in your journal between 2012 and 2013.…”

A race against time in lethal aluminum phosphide intoxication: a case report

“…In a study of Vijay Kumar Agrawal et al [7] on 7 cases, only 4 individuals could survive. Besides the symptomatic treatment after the intake of aluminum phosphide, also the dialysis is recommended for early period [7].…”

“…In a study of Vijay Kumar Agrawal et al [7] on 7 cases, only 4 individuals could survive. Besides the symptomatic treatment after the intake of aluminum phosphide, also the dialysis is recommended for early period [7]. In addition to the supportive care, N-acetyl-cysteine and glutathione and magnesium, which have been reported to have antioxidant features, are recommended [15].…”

“…Phosphine inhibits the cytochrome C oxidase [6]. It causes cellular level hypoxia and inhibition of oxidative phosphorylation [7]. At the same time, it also leads to the formation of reactive oxygen species caused from lipid peroxidation [6].…”