Methemoglobinemia in aluminum phosphide poisoning

Abstract

<jats:p> Introduction. Acute aluminum phosphide (AlP) poisoning is one of the most common causes of acute pesticide poisoning in Iran. Hydrogen phosphide or phosphine gas is produced following reaction of AlP with water even at ambient humidity. Methemoglobinemia is a rare finding following phosphine poisoning. In this paper, two cases of fatal AlP poisoning complicated by methemoglobinemia are reported. Case Report. Two patients presented following suicidal ingestion of AlP tablets. In the Emergency Department (ED), they received gastric lavage with sodium bicarbonate and potassium permanganate. Both of them received supportive care. In each case, hematuria and hemolysis were significant events. The patients also showed a decrease in O<jats:sub>2</jats:sub> saturation in spite of high FIO<jats:sub>2</jats:sub>. Methemoglobin levels of 40% and 30% were detected by co-oximetry. Neither patient responded to treatment (ascorbic acid in one case, methylene blue in the other). Both patients died due to systemic effects of phosphine poisoning. Discussion and conclusion. Hemolysis and methemoglobinemia may complicate the course of phosphine poisoning that seems resistant to methylene blue and ascorbic acid. Therefore, other treatments including hyperbaric oxygen therapy and exchange blood transfusion should be considered. </jats:p>

Coconut Oil as an Adjuvant to Magnesium Sulphate Therapy in Acute Aluminum Phosphide Consumption

“…Shadnia S et al, done a case report methemoglobin was one of the complication of ALP poisoning but not observed in present study [26].…”

A Systematic Review of Aluminium Phosphide Poisoning

“…In vitro studies (24)(25)(26)(27) suggest that phosphides are absorbed as microscopic particles of unhydrolysed salt that permanently interact with free haemoglobin and haemoglobin in intact erythrocytes (rat and human) to produce a haemichrome (a methaemoglobin derivative resulting from distorted protein conformation). In addition, Potter et al (26) report that Heinz bodies (denatured haemoglobin aggregates) are formed when phosphide concentration in vitro exceeds 1.25 μg mL -1 .…”

“…Refractory shock may result in cerebral anoxia that usually presents itself as drowsiness, delirium, and coma. Another uncommon sign is methaemoglobinaemia (27,70).…”

Response to “Blood Levels of Methemoglobin in Patients with Aluminum Phosphide Poisoning and its Correlation with Patient’s Outcome”

“…The issue of possible permanganate-induced methemoglobinemia due to gastric lavage by the recommended concentration of this agent (1:10,000) is a matter of debate that warrants further studies in this regard. However, it should be mentioned that from the three previously performed studies on the methemoglobinemia due to AlP intoxication, gastro-intestinal decontamination with potassium permanganate had been performed in one of them [2,3,6]. In the present study, as the authors have themselves declared, gastric lavage with potassium permanganate has been done for all of the patients [1].…”