Background:The high mortality incidence of acute aluminum phosphide poisoning (ALP) poses serious problems for healthcare workers, especially in developing countries. There is no precise antidote, and the treatment is mainly supportive. As a result, novel therapeutic approaches must be evaluated to reduce the morbidity and mortality. Aim of the Study: Evaluation of the safety and efficacy of gastric lavage with paraffin oil versus coconut oil as adjuvants to sodium bicarbonate 8.4% solution for ALP poisoned patients. Methods: This double-blinded, parallel-group, randomized trial (Trial ID: NCT04724655) enrolled 60 symptomatic patients of both gender who presented within two hours of ALP exposure. The patients were randomly allocated into three equal groups (20 patients each). All groups received the conventional treatment. In paraffin group, patients were subjected to gastric lavage with a mixture of paraffin oil in addition to sodium bicarbonate 8.4%. In coconut group, patients were subjected to gastric lavage with a mixture of coconut oil and sodium bicarbonate 8.4%. In the saline group, patients were subjected to gastric lavage with a mixture isotonic saline added to sodium bicarbonate. Outcomes were recorded in all groups. Results: The percentage of deaths among patients who received paraffin and coconut oily substances for gastric lavage were nonsignificantly lower than patients in the saline group. In addition, there was a significant prolongation of hospital stays with higher survival time in both paraffin and coconut treated groups than in the saline group (p <0.001). Meanwhile, there was no significant difference between the paraffin and coconut groups. Furthermore, there were no reported significant adverse events of paraffin or coconut oil use. Conclusion: Paraffin oil and coconut oil might give hope to ALP poisoned patients; lowering the need for mechanical ventilation and significantly improve the survival time in patients who received oily gastric lavage solution than the saline-based solution with no adverse events.