Incidental Aluminum Phosphide Poisoning: Case Report and Current Management

Abstract

Aluminum phosphide (AlP) is a commonly used cheap rodenticide, insecticide, and fumigant. Most intoxications in the literature are suicidal ingestions, however, AlP may cause incidental inhalational toxicities as well. After ingestion or inhalation, nausea, vomiting, dyspnea and abdominal pain develops within minutes. Hallmark of toxicity is refractory hypotension, cardiac failure and severe metabolic acidosis developing within a matter of hours are the major cause of mortality. In Turkey, AlP tablets are widely accessible and are sold without any restrictions. However, there are few local case reports in the literature. Additionally, incidental AlP intoxications are rarely reported. Herein, we present a 25-year-old male patient incidentally poisoned with AlP. He was found unconscious in a grain storage unit protected by aluminum phosphide tablets. He had hypotension and tachycardia. Arterial blood gas analysis did not reveal metabolic acidosis. He was quickly intubated and admitted to Intensive Care Unit (ICU). Supportive care crystalloid solution, n-acetyl cysteine and norepinephrine infusion was administered. After 36 hours, he was extubated and discharged without any complications. There is no specific antidote or treatment for AlP toxicity. Literature is controversial regarding treatment approach. Inhalational toxicity may occur under extreme conditions, as presented in this case report. Preventive strategies should be considered to reduce incidents. Clinicians should also be aware that AlP is a widely available and highly toxic compound that has no specific antidote and toxicity needs to be urgently treated with best supportive care.

A case of Aluminum Phosphide poisoning managed successfully in Nepal: A Case Report

“…Phosphine gas blocks cytochrome C oxidase in the mitochondria leading to disruption of oxygen transport in the electron transport chain causing cell death. It also releases reactive oxygen species (superoxide and hydrogen peroxide) that causes lipid peroxidation and cell death [7]. Some studies suggested the use of Glutathione, Vit C and E, Carotenes, and melatonin helps in reducing the oxidative stress in cases of ALP poisoning and hence better prognosis [8].…”

“…The diagnosis is mainly clinical with positive history of ALP tablets ingestion, garlic odor at presentation, and symptoms suggestive of ALP ingestion. However, silver nitrate test on gastric aspirate and gas chromatography with a nitrogenphosphorus detector can be done for diagnosis in case of doubt [7,8]. There is no specific antidote available for ALP poisoning.…”

Hopeful News for Physicians Who Involved in the Treatment of Critical Aluminum Phosphide (Rice Pill) Poisoning Patients

“…Mechanism of rice tablet toxicity includes cytochrome C oxidase inhibition by phosphine gas, oxidative injury, and lipid peroxidation that cause cellular injury. [ 6 , 8 , 9 ].…”

Inhalational Wheat-pill Poisoning: A Household Chemical Warfare Agent

“…Although aluminum phosphide poisoning is commonly seen in fumigation and via an oral route through wheat-pill ingestion, our patient accidentally got exposed to the poison while working in a damp, unaerated wheat storage unit. Our review of articles showed only one such reported case [4]. Through this article, we would like to bring to attention this rare mode of poisoning so that timely measures can be taken to avoid an unfavorable outcome, as studies have shown that timely intervention can save lives [5] especially in inhalational poisoning of aluminum phosphide [4].…”

“…Although cases of orally ingested wheat pills for suicide and poisoning by fumigation are prevalent [1], we hereby discuss the case of wheat-pill poisoning due to inhalation in a closed space. In an extensive review of literature on PubMed using the keywords “wheat pill,” “aluminum phosphide” and “poisoning,” we could find only one reported case of poisoning by aluminum phosphide due to inhalation in a closed space [4]. The objective of this article is to inform physicians about this unique mode of poisoning so that timely and appropriate management can be commenced to avoid an unfavorable outcome [5].…”