1. Suspected case of Alphos poisoning
Take personal protection measures, including full
face mask and rubber gloves during
decontamination
Secure airway, IV access preferably CVP and send
routine investigations
Gut decontamination with KMnO4(1:10,000),
vegetable or coconut oil(within 6 hrs)

2. Watch for worsening of signs and symptoms
SHOCK
• Fluid
therapy @
2-3 litres
NS in first
8 hours to
maintain
CVP of 12-
14 cms
Saline
No
response
• Low dose
dopamine
(4-6
ug/Kg/min
) and keep
systolic
BP>90 mm
Hg
Refractory
hypotensio
n
• Consider
IABP

3. ORGAN FAILURE
ALI/ARDS
Ventilatory support
Hydrocortisone 200-400 mg
every 4-6 hr IV
ARRYTHMIAS
Antiarrythmics and MgSo4 3
g as infusion over 3 h,
followed by 6 g per 24 h for
3–5 days,
Bradyarrythmia can be
considered for pacing
METABOLIC ACIDOSIS
NaHCo3 50-100 mEq IV 8
hrly till the level rises to 18-
20 mEq/L
DIALYSIS for renal failure
and severe acidosis: HDM/
PD(if hypotension present)
MANAGE ACCORDINGLY

4. SUPPORTIVE MEASURES:
• Antacids and proton pump blockers
• n-acetylcysteine, glutathione, melatonin,
vitamin C and beta carotene
• trimetazidine