2. Aluminium Phosphide
• Aluminium phosphide poisoning is the
commonest lethal poisoning encountered
in clinical practice and has taken a huge
toll of human lives during the last two
decades or so.
3. Availability
• Aluminium phosphide is marketed in India
as 0.5gm pellets,3gm tablets and in powder
form under several brand names I.e
CELPHOS,
QUICKPHOS
as food grain preservative or fumigant.
4. Toxicity
• AIP + 3 H2O = AI( OH )3 + PH3
• Phosphine gas is rapidly absorbed from the stomach
and inhibits the mitochondrial respiratory chain and
hence leads to cell necrosis and death
• Phosphine resembles Cyanide in that it inhibits
cytochrome oxidase and thereby hampers cellular
oxygen utilization
Indian Journal of Pharmacology 1992 SK Tripathi et
al
5. • Phosphine gas is actually colourless and odourless
However
• Due to presence of substituted diphosphines on
exposure to air it gives garlicky or decaying fishy odour
• Lethal Dose – 0.5 gm for a 70 kg person
6. Clinical Presentation
• Initial symptoms like
-retrosternal burning
-epigastric pain
-vomiting
-hypotension(cardinal feature)
-restlessness,tachypnoea,oliguria or
anuria,jaundice,impaired sensorium,cardiac
arrthymias(due to myocardial necrosis)
9. Pathophysiology
• Various studies have shown that
• Phosphine will inhibit mitochondrial oxygen uptake
and ion stimulated respiration
• which also has direct effect on the electron
transport system which is an important
electrochemical link between respiration and
phosphorylation in mitochondria.
10. Diagnosis :
• Clinical History
• Detection of phosphine in exhaled air or gastric aspirate
by using silver nitrate impregnated strips.
• For spot sampling of phosphine, commercial air
detector tubes and bulbs are available
• Most specific and sensitive test is gas
chromatography(can detect minute amount of
phosphene in air, used for research purposes mainly )
• Cytochrome-c oxidase activity in platelets is another
marker.
11. Management :
• The management continues to be unsatisfactory as
there is no specific antidote and remains supportive
only.
• Number of vomits after ingestion and severity of
shock-correlates best with outcome.
12. Management :
• There is no RCTS to show gastric lavage will benefit
these patients.
• Potassium permanganate (1:10000)has been tried for
removing the unabsorbed phosphine as well as to
oxidize it.
• Activated charcoal 50-100gm activated charcoal is
given orally to adsorb phosphene.
• Medicated liquid paraffin
13. Management …
• The main factor is treatment of shock and
hypotension with appropriate measures
• SHOCK / HYPOTENSION – Fluids ,
Vasopressors
• Phosphine is excreted by lungs and kidney. To
enhance its excretion adequate BP and renal
perfusion needs to be maintained.
14. • Magnesium sulphate
-Membrane stabilizer which can reverse
arrhythmias.
-Antiperoxidant activity
-It has been claimed to reduce mortality
• Corticosteriods-in compromised adrenal function
Management ….
