Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 12 ( December, 2021 ) > List of Articles

CASE REPORT

Venoarterial Extracorporeal Membrane Oxygenation is Effective in Severe Aluminum Phosphide Overdose Despite Delayed Presentation

Pradeep Kumar HG, A Madhusudan Kalluraya, C Jithendra, Ashwin Kumar, Sudhindra P Kanavehalli, Arul D Furtado

Keywords : Aluminum phosphide, ECMO, Multi-organ dysfunction

Citation Information : HG PK, Kalluraya AM, Jithendra C, Kumar A, Kanavehalli SP, Furtado AD. Venoarterial Extracorporeal Membrane Oxygenation is Effective in Severe Aluminum Phosphide Overdose Despite Delayed Presentation. Indian J Crit Care Med 2021; 25 (12):1459-1461.

DOI: 10.5005/jp-journals-10071-24041

License: CC BY-NC 4.0

Published Online: 17-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aluminum phosphide (ALP) is a potentially lethal poison. The mortality rate in ALP overdose is close to 100%. ALP has no specific antidote, and only supportive therapy is possible, with timely extracorporeal support mentioned as a modality. We present a case of severe ALP overdose in a young female with delayed presentation (>24 hours) and multiorgan failure (MOF)/shock successfully managed with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Unique features of this case include consumption of lethal quantity of ALP (5 g), severe toxicity with MOF, and shock secondary to a delayed presentation, all of which incrementally added to a high mortality. This was managed with the help of VA-ECMO as a last option with a successful outcome. This highlights the fact that late ECMO deployment, despite absorption of a large quantity and MOF/shock/acidosis, can still be salvageable with appropriate management.


HTML PDF Share
  1. Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol 2005;24(6):279–285. DOI: 10.1191/0960327105ht527oa.
  2. Kumar A, Pathak A, Verma A, Kumar S. Accidental inhalational poisoning by multiple pesticides of organophosphorus group in an aged person; an uncommon occurrence. J Forensic Med Toxicol 2012;29(2):78–83.
  3. Wahab A, Zaheer MS, Wahab S, Khan RA. Acute aluminium phosphide poisoning: an update. Hong Kong J Emerg Med 2008;15:152–155. DOI: 10.1177%2F102490790801500306.
  4. Sudakin DL. Occupational exposure to aluminium phosphide and phosphine gas? A suspected case report and review of the literature. Hum Exp Toxicol 2005;24(1):27–33. DOI: 10.1191%2F0960327105ht496oa.
  5. Chugh SN, Ram S, Sharma A, Arora BB, Saini AS, Malhotra KC. Adrenocortical involvement in aluminium phosphide poisoning. Indian J Med Res 1989;90:289–294. PMID: 2620956.
  6. Chugh SN, Dushyant, Ram S, Arora B, Malhotra KC. Incidence & outcome of aluminium phosphide poisoning in a hospital study. Indian J Med Res 1991;94:232–235. PMID: 1937606.
  7. Wahab A, Rabbani MU, Wahab S, Khan RA. Spontaneous self-ignition in a case of acute aluminium phosphide poisoning. Am J Emerg Med 2009;27(6):752. DOI: 10.1016/j.ajem.2008.09.045.
  8. Moghadamnia AA. An update on toxicology of aluminum phosphide. Daru 2012;20(1):25. DOI: 10.1186/2008-2231-20-25.
  9. Tripathi SK, Gautam CS, Sharma PL. Clinical pharmacology of aluminium phosphide poisoning. Ind J Pharmacol 1992;24(3):134–137.
  10. Jain AK, Nigam M, Garg SD, Dubey BP, Arora A. Aluminium phosphide poisoning autopsy findings. J Indian Academy Forensic Med 2005;27(1):35–39.
  11. Arora B, Punia RS, Kalra R, Chugh SN, Arora DR. Histopathological changes in aluminium phosphide poisoning. J Indian Med Assoc 1995;93(10):380–381. PMID: 9053411.
  12. Chugh SN, Chugh K, Ram S, Malhotra KC. Electrocardiographic abnormalities in aluminium phosphide poisoning with special reference to its incidence, pathogenesis, mortality and histopathology. J Indian Med Assoc 1991;89(2):32–35. PMID: 2056173.
  13. Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J 2006;23(1):3. DOI: 10.1136/emj.2004.015941.
  14. Bhasin P, Mital HS, Mitra A. An echocardiographic study in aluminium phosphide poisoning. J Assoc Phys India 1991;39:851.
  15. Gupta MS, Malik A, Sharma VK. Cardiovascular manifestations in aluminium phosphide poisoning with special reference to echocardiographic changes. J Assoc Phys India 1995;43(11):773–774, 779–780. PMID: 8773039.
  16. Chauhan M, Dewan S, Attawar S, Kamat S, Kumar V, Manhas V, et al. Successful treatment of cardiotoxicity of aluminium phosphide poisoning with extracorporeal membrane oxygenation (ECMO): a case report. J Pharmacol Clin Toxicol 2015;3(4):1056.
  17. Mathai A, Bhanu MS. Acute aluminium phosphide poisoning: can we predict mortality? Indian J Anaesth 2010;54(4):302–307. DOI: 10.4103/0019-5049.68372.
  18. Hosseinian A, Pakravan N, Rafiei A, Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: a common toxicity in North Iran. Indian J Med Sci 2011;65(4):143–150. DOI: 10.4103/0019-5359.104777.
  19. Shadnia S, Mehrpour O, Soltaninejad K. A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome. Indian J Med Sci 2010;64(12):532–539. DOI: 10.4103/0019-5359.75928.
  20. Paden ML, Conrad SA, Rycus PT, Thiagarajan RR, ELSO Registry. Extracorporeal Life Support Organization registry report 2012. ASAIO J 2013;59(3):202–210. DOI: 10.1097/MAT.0b013e3182904a52.
  21. Mohan B, Gupta V, Ralhan S, Gupta D, Puri S, Mahajan R, et al. Impact of extra-corporeal membrane oxygenation on outcome of aluminium phosphide poisoning complicated with myocardial dysfunction. Clin Toxicol 2019;57(11):1095–1102. DOI: 10.1080/15563650.2019.1584297.
  22. Mohan B, Singh B, Gupta V, Ralhan S, Gupta D, Puri S, et al. Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: an observational study. Indian Heart J 2016;68(3):295–301. DOI: 10.1016/j.ihj.2016.03.024.
  23. Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1866 adult patients. Ann Thorac Surg 2014;97(2):610–616. DOI: 10.1016/j.athoracsur.2013.09.008.
  24. Jackson KW, Timpa J, McIlwain RB, O'Meara C, Kirklin JK, Borasino S, et al. Side-arm grafts for femoral extracorporeal membrane oxygenation cannulation. Ann Thorac Surg 2012;94(5):e111–e112. DOI: 10.1016/j.athoracsur.2012.05.064.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.