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VOLUME 19 , ISSUE 2 ( 2015 ) > List of Articles

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

Vijay Kumar Agrawal, Ranjeet Kumar Singh, Bhanwar Lal Kumawat, Parul Mahajan

Keywords : Aluminum phosphide, coconut oil, magnesium sulfate, phosphine gas, potassium permanganate

Citation Information : Agrawal VK, Singh RK, Kumawat BL, Mahajan P. Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote. Indian J Crit Care Med 2015; 19 (2):109-112.

DOI: 10.4103/0972-5229.151019

License: CC BY-ND 3.0

Published Online: 00-02-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


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.


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  1. Siwach SB, Yadav DR, Arora B, Dalal S, Jagdish. Acute aluminum phosphide poisoning - An epidemiological, clinical and histo-pathological study. J Assoc Physicians India 1988;36:594-6.
  2. Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2012;63:61-73.
  3. Goel A, Aggarwal P. Pesticide poisoning. Natl Med J India 2007;20:182-91.
  4. Mehrpour O, Alfred S, Shadnia S, Keyler DE, Soltaninejad K, Chalaki N, et al. Hyperglycemia in acute aluminum phosphide poisoning as a potential prognostic factor. Hum Exp Toxicol 2008;27:591-5.
  5. Ranga GS, Dwivedi S, Agarwal M, Kumar D. Aluminium phosphide poisoning in a young adult: A suicidal cardiotoxin simulating myocardial ischaemia. J Indian Acad Clin Med 2004;5:369.
  6. Siwach SB, Jagdish K, Katyal VK, Dhall A, Bhardwaj G. Prognostic indices in aluminium phosphide poisoning: Observations on acidosis and central venous pressure. J Assoc Physicians India 1997;45:693-5.
  7. Nejad FT, Mohammadi AB, Behnoush B, Kazemifar A, Nahandi MZ, Dabiran S, et al. Predictors of poor prognosis in aluminium phosphide intoxication. Iran J Toxicol 2012;6:610-4.
  8. Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci 2009;63:227-34.
  9. Jaiswal S, Verma RK, Tewari N. Aluminum phosphide poisoning: Effect of correction of severe metabolic acidosis on patient outcome. Indian J Crit Care Med 2009;13:21-4.
  10. Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: A review of literature. Forensic Sci Int 2012;214:1-6.
  11. Mehrpour O, Aghabiklooei A, Abdollahi M, Singh S. Severe hypoglycemia following acute aluminum phosphide (rice tablet) poisoning; a case report and review of the literature. Acta Med Iran 2012;50:568-71.
  12. Nasri Nasrabadi Z, Marashi SM. Comments on "A systematic review of aluminium phosphide poisoning". Arh Hig Rada Toksikol 2012;63:551.
  13. Marashi SM, Majidi M, Raji Asadabadi H, Nasri-Nasrabadi Z. A common misconception in the management of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2013;64:475-6.
  14. Gupta A, Beg M, Mohammed J, Azfar SF, Akhtar N. Coconut oil and aluminium phosphide poisoning. SAFCON-2007 South Asian and VII Annual Conference of Indian Congress Forensic Medicine and Toxicology. March 24-25, 2007.
  15. Singh Bajwa SJ, Bajwa Kaur SK, Kaur J, Singh K, Panda A. Management of celphos poisoning with a novel intervention: A ray of hope in the darkest of clouds. Anesth Essays Res 2010;4:20-4.
  16. Shadnia S, Rahimi M, Pajoumand A, Rasouli MH, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: Possible benefit of coconut oil. Hum Exp Toxicol 2005;24:215-8.
  17. Chugh SN, Juggal KL, Sharma A, Arora B, Malhotra KC. Magnesium levels in aluminium phosphide poisoning. J Assoc Physicians India 1990;38:32.
  18. Chugh SN, Kumar P, Aggarwal HK, Sharma A, Mahajan SK, Malhotra KC. Efficacy of magnesium sulphate in aluminium phosphide poisoning - comparison of two different dose schedules. J Assoc Physicians India 1994;42:373-5.
  19. Singh UK, Chakraborty B, Prasad R. Aluminium phosphide poisoning: A growing concern in pediatric population. Indian Pediatr 1997;34:650-1.
  20. Siwach SB, Singh P, Ahlawat S, Dua A, Sharma D. Serum and tissue magnesium content in patients of aluminium phosphide poisoning and critical evaluation of high dose magnesium sulphate therapy in reducing mortality. J Assoc Physicians India 1994;42:107-10.
  21. Siddaiah L, Adhyapak S, Jaydev S, Shetty G, Varghese K, Patil C, et al. Intra-aortic balloon pump in toxic myocarditis due to aluminum phosphide poisoning. J Med Toxicol 2009;5:80-3.
  22. Mehrpour O, Amouzeshi A, Dadpour B, Oghabian Z, Zamani N, Amini S, et al. Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Arh Hig Rada Toksikol 2014;65:121-6.
  23. Shadnia S, Soltaninejad K, Hassanian-Moghadam H, Sadeghi A, Rahimzadeh H, Zamani N, et al. Methemoglobinemia in aluminum phosphide poisoning. Hum Exp Toxicol 2011;30:250-3.
  24. Bajpai SR. Aluminium phosphide poisoning: Management and prevention. J Indian Acad Forensic Med 2010;32:352-4.
  25. Hsu CH, Chi BC, Liu MY, Li JH, Chen CJ, Chen RY. Phosphine-induced oxidative damage in rats: Role of glutathione. Toxicology 2002;179:1-8.
  26. Chugh SN, Kolley T, Kakkar R, Chugh K, Sharma A. A critical evaluation of anti-peroxidant effect of intravenous magnesium in acute aluminium phosphide poisoning. Magnes Res 1997;10:225-30.
  27. Marashi SM, Arefi M, Behnoush B, Nasrabad MG, Nasrabadi ZN. Could hydroxyethyl starch be a therapeutic option in management of acute aluminum phosphide toxicity? Med Hypotheses 2011;76:596-8.
  28. Mehrpour O, Farzaneh E, Abdollahi M. Successful Treatment of aluminum phosphide poisoning with digoxin: A case report and review of literature. Int J Pharmacol 2011;7:761-4.
  29. Saidi H, Shokraneh F, Ghafouri HB, Shojaie S. Effects of hyperbaric oxygenation on survival time of aluminum phosphide intoxicated rats. J Res Med Sci 2011;16:1306-12.
  30. Dueñas A, Pérez-Castrillon JL, Cobos MA, Herreros V. Treatment of the cardiovascular manifestations of phosphine poisoning with trimetazidine, a new antiischemic drug. Am J Emerg Med 1999;17:219-20.
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