Successful Management of an Aluminum Phosphide Poisoned Patient Following Ventricular Tachycardia

Abstract

Aluminum Phosphide (ALP) poisoning is regarded as fatal; however, it is commonly used in developing countries. In some countries, such as India and Iran, it is still being used to protect grain against pests at home. As yet, no known antidote is reported to be effective against ALP poisoning. ALP acts through blockage of cell respiration, alteration of cell permeability, and induction of oxidative stress. Some factors can worsen the prognosis of its intoxication, which include hyperglycemia on admission, ingestion of fresh tablets, cardiac abnormality, especially Ventricular Tachycardia (VT), severe metabolic acidosis, cardiogenic shock and other types of shocks, electrolyte disturbances, end-organ damage, and a need for mechanical ventilation. ALP kills its victims by induction of multi-organ failure. In this study, we controlled the patient’s VT using MgSO4, electric shock, amiodarone, and lidocaine. We also encountered the cardiogenic shock using norepinephrine, High-Dose Insulin (HDI), antioxidants, sodium bicarbonate, and normal saline. Moreover, myocardial ischemia, recurrent VTs, and adverse cardiac effects were protected via tight control of magnesium and other electrolytes.

The Treatment Results in Patients with Aluminum Phosphide Toxicity Admitted to Razi Hospital in Ahvaz

“…However, given the high percentage of dead patients from dispatched ones, confounding factors seem to be effective in investigating the relationship between dispatching and death. For example, reviewing the files of patients who have been directly undergone CPR or patients who have been admitted after the risk alleviation shows that more principled treatment in the primary centers increases the possibility of rescuing the patient [14]. Clinical manifestations: Nausea and vomiting, abdominal pain, dizziness and headache, epigastric pain, thirst and weakness, and lethargy were the most common conditions reported by patients, which are consistent with other studies.…”

Effects of melatonin and N-acetylcysteine on aluminum phosphide poisoning in rats

“…Rice tablet is a chemical compound that is widely used as an effective rodenticide and insecticide to protect grains during storage and transportation in developing countries. [ 14 ] The exact mechanism of the effects of aluminum phosphide in humans is not clear, and it seems that severe cell damage is the main target of the function of aluminum phosphide (ALP). [ 15 16 ] In vitro, phosphine gas has been shown to inhibit cytochrome oxidase C in mitochondria; this enzyme plays an important role in the respiratory system and cellular metabolism, and inhibition of this enzyme causes cellular hypoxia and extensive tissue damage.…”

“…[ 15 16 ] In vitro, phosphine gas has been shown to inhibit cytochrome oxidase C in mitochondria; this enzyme plays an important role in the respiratory system and cellular metabolism, and inhibition of this enzyme causes cellular hypoxia and extensive tissue damage. [ 14 17 ] Electron current disturbance also causes the emergence of free radicals and the destruction of multiple organs. Evidence of toxicity with oxygen free-radicals generated as a result of ALP poisoning has been observed in mice.…”

Investigation of the effect of N-acetylcysteine on aluminum phosphide toxicity in rats

“…As ALP is easily absorbed from the gastrointestinal tract and lung epithelium, the severity of poisoning is high at both gastrointestinal and respiratory level. 3 The electron transfer chain, which is inhibited by this gas, ultimately causes cellular respiration to cease. These modifications cause the production of free radicals, which can harm organs.…”