Unusual complication of aluminum phosphide poisoning: Development of hemolysis and methemoglobinemia and its successful treatment

Soltaninejad, Kambiz; Nelson, Lewis S.; Khodakarim, Nastaran; Dadvar, Zohreh; Shadnia, Shahin

doi:10.4103/0972-5229.83021

Cited by 24 publications

(21 citation statements)

References 9 publications

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“…2,3 Many reports have proposed experimental or individual case treatments for A1P poisoning, including digoxin; N-acetylcysteine; hyperbaric oxygen; magnesium ( 25 Mg 2+ )-carrying nanoparticles; intragastric irrigation with sweet almond oil; a combination of vitamin C and methylene blue; extensive gastric lavage with coconut oil and a sodium bicarbonate solution with simultaneous aspiration; perfusion with an intraaortic balloon pump; Nω-nitro-L-arginine methyl ester; a combination of atropine and pralidoxime; and trimetazidine. [12][13][14][15][16][17][18][19][20][21] However, no specific antidote has yet been found for the routine treatment of AlP poisoning and unfortunately most people who are poisoned do not survive. [2][3][4] Recently, boric acid has been theoretically proposed as an antidote for AlP poisoning.…”

Section: Application To Patient Care -The Results Of This Study May Bmentioning

confidence: 99%

Chemical Reaction between Boric Acid and Phosphine Indicates Boric Acid as an Antidote for Aluminium Phosphide Poisoning

Soltani¹,

Shetab-Boushehri²,

Shetab-Boushehri³

2016

SQUMJ

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Objectives: Aluminium phosphide (AlP) is a fumigant pesticide which protects stored grains from insects and rodents. When it comes into contact with moisture, AlP releases phosphine (PH 3 ), a highly toxic gas. No efficient antidote has been found for AlP poisoning so far and most people who are poisoned do not survive. Boric acid is a Lewis acid with an empty p orbital which accepts electrons. This study aimed to investigate the neutralisation of PH 3 gas with boric acid. Methods: This study was carried out at the Baharlou Hospital, Tehran University of Medical Sciences, Tehran, Iran, between December 2013 and February 2014. The volume of released gas, rate of gas evolution and changes in pH were measured during reactions of AlP tablets with water, acidified water, saturated boric acid solution, acidified saturated boric acid solution, activated charcoal and acidified activated charcoal. Infrared spectroscopy was used to study the resulting probable adduct between PH 3 and boric acid. Results: Activated charcoal significantly reduced the volume of released gas (P <0.01). Although boric acid did not significantly reduce the volume of released gas, it significantly reduced the rate of gas evolution (P <0.01). A gaseous adduct was formed in the reaction between pure AlP and boric acid. Conclusion: These findings indicate that boric acid may be an efficient and non-toxic antidote for PH 3 poisoning. Advances in Knowledge -The results of the present study show that phosphine (PH 3 ) reacts with boric acid and produces a gaseous adduct.-Activated charcoal was found to significantly reduce the volume of released PH 3 gas, while boric acid significantly reduced the rate of gas evolution.-The time taken for the production of a lethal volume of PH 3 gas was 6.5-21 minutes.

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Section: Application To Patient Care -The Results Of This Study May Bmentioning

confidence: 99%

Chemical Reaction between Boric Acid and Phosphine Indicates Boric Acid as an Antidote for Aluminium Phosphide Poisoning

Soltani¹,

Shetab-Boushehri²,

Shetab-Boushehri³

2016

SQUMJ

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“…Hence, many authors have proposed to correct this complication by administration of intravenous sodium bicarbonate. [213539]…”

Section: Management Of Severe Metabolic Acidosismentioning

confidence: 99%

“…[16] Other probable mechanisms were explained by some authors as reactive oxygen species overproduction, intracellular lipid peroxidation, heart failure, insufficiency in vascular wall integrity, inhibition of cholinesterase activity, hemolysis, methemoglobinemia, and corrosive effects on alimentary mucosa. [16171819202122]…”

Section: Introductionmentioning

confidence: 99%

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

Farahani

Soroosh

Marashi

2016

Indian Journal of Critical Care Medicine

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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.

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“…[1] Two major points should not be missed about this case; firstly, although the authors have stated that methemoglobinemia is a rare finding following ALP poisoning, it seems that in all patients with this poisoning, methemoglobinemia is present to some degrees. [2–6] Therefore, it should be emphasized that symptomatic methemoglobinemia-but not methemoglobinemia itself- is a rare finding in this setting.…”

mentioning

confidence: 99%

“…The authors hypothesize that this difference in response to therapy may be due to the severity of toxicity, inappropriate dose of methylene blue, and the physiological differences between the patients. [1] The point they may have missed is gastric lavage with potassium permanganate. As you know, potassium permanganate is a strong hemolytic and oxidizing agent that can induce hemolysis and methemoglobinemia.…”

mentioning

confidence: 99%

Aluminum phosphide poisoning and development of hemolysis and methemoglobinemia

Sanaei‐Zadeh

2012

Indian Journal of Critical Care Medicine

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Unusual complication of aluminum phosphide poisoning: Development of hemolysis and methemoglobinemia and its successful treatment

Cited by 24 publications

References 9 publications

Chemical Reaction between Boric Acid and Phosphine Indicates Boric Acid as an Antidote for Aluminium Phosphide Poisoning

Chemical Reaction between Boric Acid and Phosphine Indicates Boric Acid as an Antidote for Aluminium Phosphide Poisoning

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

Aluminum phosphide poisoning and development of hemolysis and methemoglobinemia

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