Aluminium phosphide poisoning with severe cardiac dysfunction and the role of digoxin

Abstract

Aluminium phosphide (ALP) is a common cause of suicidal poisoning in India where it is easily available and commonly known as 'rice tablet'. In rural areas of India, it is still used to protect rice and stored grains from rodents and pests. There is no specific antidote for phosphide poisoning and treatment involves meticulous supportive care. Ingestion can lead to severe cardiac suppression and cardiogenic shock. For patients poisoned with ALP who continue to have refractory shock with persistent myocardial suppression despite the use of adrenergic inotropic agents, the addition of digoxin may be beneficial. We present a case where digoxin was utilised with beneficial patient outcomes.

Successful Management of an Aluminum Phosphide Poisoned Patient Following Ventricular Tachycardia

“…Some factors are known to improve the prognosis of ALP intoxication, which include younger age, ALP gas aspiration, drinking of ALP solution instead of tablet ingestion, vomiting following ingestion, and/or low-dose ingestion. On the other hand, some factors can worsen the prognosis of its intoxication, including hyperglycemia on admission, ingestion of fresh tablet, cardiac abnormality, especially VT, severe metabolic acidosis, cardiogenic shock and other types of shocks, electrolyte disturbances, other end-organ damages, and a need for mechanical ventilation [2,[4][5][6][7]. By induction of multi-organ failure, ALP kills its victims.…”

“…VT in these patients is treated by amiodarone and Magnesium Sulfate (MgSO4), but it is still known as an indicator of poor prognosis among ALP poisoned patients [5]. Several case report studies have indicated the successful cardioversion from VT to the sinus rhythm using MgSO4 and amiodarone [6]. Although using lidocaine could cardiovert patients with VT rhythm to sinus rhythm, in some other studies, it could not be cardioverted [7].…”

Acute Heart Failure Due to Aluminum Phosphide Poisoning

“…Diagnosis is based on exposure history, gastric aspirate analysis, gas chromatography study/mass spectrometry method, or on the presence of specific phosphine odor (smell of garlic or decaying fish). 1 , 2…”

“…Aluminum phosphide (ALP) is commonly a suicidal agent in some countries; however, accidental poisoning is rare. 1 Myocardial damage occurs in 60% to 100% of cases of ALP intoxication. It can manifest as pericarditis or myocarditis, new-onset heart failure, subendocardial infarction, refractory hypotension, and shock.…”

Inhalational Wheat-pill Poisoning: A Household Chemical Warfare Agent

“…Other articles spoke favorably about other antidotes, including triiodothyronine, acetyl-L-carnitine, glutathione, liothyronine, milrinone, Laurus nobilis L, vasopressin, sodium selenite, sulfate, N-acetylcysteine, 6-aminonicotinamide, boric acid, melatonin, vitamins C and E [10], selegiline [11], and whole blood transfusion [12]. Other articles reviewed the roles of digoxin [13], extracorporeal cardiopulmonary resuscitation [14], aortic balloon [15], and prophylactic amiodarone for symptomatic improvement in cardiac function [16]. In another article, the authors discussed the protective role of G6PD deficiency in wheat pill poisoning [17].…”