Hot charcoal vomitus in aluminum phosphide poisoning - A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature

Abstract

Aluminium phosphide (ALP) poisoning is a commonly encountered poisoning in emergency departments in most developing countries. Many papers have revealed metabolic derangements in this poisoning and also examined contributing factors leading to death, but only few have reported physical damage. Some case reports have described a complication that has been frequently termed ‘ignition’. The exact mechanism of this phenomenon has not been fully elucidated. An exothermic reaction during therapeutic administration of chemicals may contribute to this problem, but the incidence has occurred in the absence of treatment or drug administration. Here, we report a 34-year-old woman with ALP poisoning who presented with hot charcoal vomitus, a sign of internal thermal event, leading to the thermal burning of the patient's face and internal damage resulting in death. We reviewed all reported cases with similar complication to demonstrate varied characteristics of patients and to propose the possible mechanisms leading to this event.

Successful management of aluminium phosphide poisoning using intravenous lipid emulsion: Report of two cases

“…[ 13 ] Mirakbari described that KMnO 4 is an oxidizing agent and reduced to manganese dioxide and KOH by an exothermic reaction posing health hazard to patient as well as attending physician. [ 14 ] Bajwa et al . and Shadnia et al .…”

Proposal for a new mechanism of action for aluminum phosphide (ALP) for causing local injuries in ALP poisoning

“…2 Moreover, he has elucidated on ALP-induced burning and the exothermic and thermal burning effects from solid and gasous agents. 2 Thermal injuries ranged from gastrointestinal ulcers and hemorrhages to external dermal burns resulting in death.…”

“…Attenuating by injecting an inert gas Hot atmosphere, high temperature 3,4 Hypothermia induction, transferring to cold area Negative pressure due to suctioning 3,5 Eliminating nasogastric suctioning from available interventions a Friction from nasogastric tube 5 Eliminating nasogastric lavage from available interventions a Exothermic reaction between potassium permanganate and organic matters 2,6 Elimination of potassium permanganate from treatment plan ALP: aluminum phosphide. a In both cases, instead of nasogastric lavage and suctioning, gastric ventilation is suggested to insufflate an inert gas into the stomach.…”

Possible Protective Effect of Alpha Lipoic Acid Against Ricin Induced Hepatotoxicity in Adult Male Albino Rats

“…Oxidative degradation of lipids known as lipid peroxidation, and other oxidant mechanisms damage biological macromolecules specially the cell membrane ultimately leading to cell death (Yousef, et al, 2015). Oxidative stress, caused by an imbalance between free radicals production and their elimination by antioxidants, has been recognized as a central contributor to cellular injury and death (Mirakbari, 2015).…”