DR.

ROBY RAJAN

The history ofpoison stretches from before

4500 BC to thepresent day Organophosphates, organochlorines and carbamates were most frequently misused substances till recent past. Almost non-existent two and half decades ago, aluminium phosphide poisoning has now become popular and presently used due to its low cost, easy availability.

Aluminium phosphide is a solid fumigant

pesticide widely used as a grain preservative

Greenish gray tablets (packed in metal tubes,

weighing 3 gms each capable of liberating 1 gm of phosphine gas).

AlP +3HCL = ALCl3 + PH3 AlP + 3H2O = Al (OH) 3 + PH3

The fatal dose of aluminium phosphide in

human is 150-500 mg for a 70 kg person !!!!!!!!!!!

1/6th of a tablet

!!!!!!!!!

Phosphine is colourless, odourless (when

pure), inflammable gas soluble in both water and organic solvents

The foul odour (of garlic/decaying fish) of

aluminium phosphide is due to presence of substituted phosphine and diphosphine (P2H2) on ingestion of tablet.

Phosphine is liberated in the stomach and

absorbed rapidly from gastrointestinal tract. On inhalation it is absorbed from lungs. After absorption it is oxidized slowly to oxyacids and excreted in urine as hypophosphide.

Phosphine is a potent inhibitor of cytochrome

c-oxidase leading to impaired energy metabolism Inhibitor of mitochondrial enzyme catalase and induction of super oxide dismutase (SOD) lead to free radical stress which brings out lipid peroxidation and protein denaturation of cell membrane leading to hypoxic cell damage.

ALP poisoning is either inhalational or

ingestional.

Respiratory Acute respiratory distress syndrome (ARDS)

and exudative pleural effusions can develop.

Cardiovascular Various changes in ECG ST segment

elevation/depression, PR and QRS interval prolongation, complete heart block to ectopics and fibrillation have been observed

CNS Restlessness, drowsiness and delirium, all due

to shock and acidosis. Gastrointestinal Vomiting, abdominal pain can occur initially. Esophageal stricture Tracheo-esophageal fistula

Histopathologically on gross examination,

almost all the vital organs were found to be congested

Out of all cardiotoxicity is the major cause of

death emphasizing the need of intensive cardiac monitoring.

confirmed by detecting phosphine in exhaled

air or in stomach aspirate.

AgNO3 impregnated filter paper is turned black by PH3

In the absence of specific antidote, the main

aim of management is to sustain life with supportive measures till PH3 (phosphine) is excreted through the lungs and kidney.
250-500 ml of mineral oil or vegetable oil via

Ryles tube to be left in situ along with activated charcoal

The risk of aspiration needs to be kept in

mind.

Mg 2 +ions of magnesium sulphate help in

scavenging free radicals through glutathione recovery, hence is effective as parenteral antioxidant in this poisoning. Magnesium is antihypoxic and antiarrhythmic agent, a membrane stabiliser
IV MgSO4 1 gm IV stat ----1 gm IV hourly for 3

hours----- 1 gm Q4H
Xanthinol Nicotinate 100-150 ng/ml have

shown promising results in animal studies

Supportive care in terms of fluid electrolyte

balance , dailysis for renal failure

Mechanical ventilation for

ARDS

Iv Hydrocortisone 300-400 mg / day