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

Zinc phosphide (Zn2P3) rodenticide, is generally misused intentionally for suicidal purpose in Iran. For many years, scientists believe that liberation of phosphine (PH3) on contact with acidic content of the stomach is responsible for clinical presentations. However, relatively long time interval between ingestion of Zn2P3 and presentation of its systemic toxicity, and progression of acute liver failure could not be explained by the current opinion. Hence, an innovative theory intended that phosphonium, as an intermediate product will create and pass through the stomach, which then will reduce to produce PH3in the luminal tract. Here, we present a case of massive Zn2P3 poisoning. In our case, we used repeated doses of castor oil to induce bowel movement with an aim of removing unabsorbed toxin, which was proved by radiography. Interestingly, the patient presents only mild symptoms of toxicity such as transient metabolic acidosis and hepatic dysfunction.

Section: Discussionmentioning

confidence: 99%

Successful management of zinc phosphide poisoning

Shakoori

Agahi

Vasheghani-Farahani

et al. 2016

“…Marashi and Nasri-Nasrabadi proposed use of hydroxyethyl starch in ALP poisoning with induced shock and arterial pH > 7 to resolve symptoms of shock and increase arterial pH without the use of sodium bicarbonate. [ 22 ] Furthermore, Cooper et al . [ 23 ] reported no beneficial hemodynamic effect of sodium bicarbonate in patients with severe lactic acidosis.…”

Section: Discussionmentioning

confidence: 99%

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

Baruah¹,

Sahni²,

Sachdeva³

2015

Aluminum phosphide (ALP) is a cheap, easily available agricultural pesticide which causes lethal poisoning by liberation of phosphine and inhibition of cytochrome c oxidase thereby leading to cellular hypoxia. Although there is no known specific antidote, clinical trials are still going on. We present here two cases of ALP poisoning who were successfully managed by treatment with lipid emulsion and intravenous magnesium sulfate.

“…[16] In this context, refractory metabolic acidosis may be a reflection of organ hypoperfusion. [33]…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Therefore, we can expect some degrees of correction of circulatory pH along with intensifying intracellular acidosis. [3356]…”

Section: Management Of Severe Metabolic Acidosismentioning

confidence: 99%

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Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An Evidence-based review

Farahani

Soroosh

Marashi

2016

The majority of aluminum phosphide (ALP) toxicity cases are suicidal attempts. Despite advances in critical care medicine, the mortality rate of ALP remains very high. Unfortunately, knowledge on the toxicokinetics of ALP is very low. An obsolete idea was proposed that inhibition of complex IV of cytochrome C oxidase is responsible for multiorgan dysfunction. However, based on human studies, this effect might be insignificant. Thus, a novel idea proposes that the main mechanism might be vascular wall integrity disruption. The low frequency of acute toxicity and unanswered questions about the toxicokinetics and toxicodynamics has led to leaden advances of novel treatments. The aim of this review was to evaluate problems regarding current treatment protocols and propose new ideas based on updated information. For this purpose, we reviewed all available articles on the management of ALP poisoning published to date. Considering failure of conventional therapies on maintaining systolic blood pressure, correcting acid-base disturbances, and support cardiac function, the previous treatment protocols have been overruled. However, repudiate of conventional treatments in this deadly condition is not without penalties for the health-care provider. The introduction of new therapies including refuse of gastric lavage with water-soluble compounds, administration of a high molecular weight colloidal solution for fluid resuscitation and termination using sodium bicarbonate, and vasoactive agents has been prospected to improve patient survival. This protocol is in early clinical evaluation; nevertheless, it appears to improve patient's survival; hence, future randomized trials should be performed to support their effectiveness.