A Systematic Review of Aluminium Phosphide Poisoning

A Systematic Review of Aluminium Phosphide Poisoning Every year, about 300,000 people die because of pesticide poisoning worldwide. The most common pesticide agents are organophosphates and phosphides, aluminium phosphide (AlP) in particular. AlP is known as a suicide poison that can easily be bought and has no effective antidote. Its toxicity results from the release of phosphine gas as the tablet gets into contact with moisture. Phosphine gas primarily affects the heart, lungs, gastrointestinal tract, and kidneys. Poisoning signs and symptoms include nausea, vomiting, restlessness, abdominal pain, palpitation, refractory shock, cardiac arrhythmias, pulmonary oedema, dyspnoea, cyanosis, and sensory alterations. Diagnosis is based on clinical suspicion, positive silver nitrate paper test to phosphine, and gastric aspirate and viscera biochemistry. Treatment includes early gastric lavage with potassium permanganate or a combination with coconut oil and sodium bicarbonate, administration of charcoal, and palliative care. Specific therapy includes intravenous magnesium sulphate and oral coconut oil. Moreover, acidosis can be treated with early intravenous administration of sodium bicarbonate, cardiogenic shock with fluid, vasopresor, and refractory cardiogenic shock with intra-aortic baloon pump or digoxin. Trimetazidine may also have a useful role in the treatment, because it can stop ventricular ectopic beats and bigeminy and preserve oxidative metabolism. This article reviews the epidemiological, toxicological, and clinical/pathological aspects of AlP poisoning and its management. Sustavni pregled otrovanja aluminijevim fosfidom Svake godine u svijetu oko 300.000 ljudi umre od trovanja pesticidima. Najčešći pesticidni spojevi su organofosfati i fosfidi, ponajviše aluminijev fosfid. On je poznat kao otrov samoubojica, jer ga je lako nabaviti, a nema djelotvornoga protuotrova. Toksičnost duguje otpuštanju fosfinskoga plina u trenutku kada tableta dođe u dodir s vlažnim okružjem. Fosfinski plin ponajviše djeluje na srce, pluća, probavni sustav i bubrege. Znakovi i simptomi trovanja obuhvaćaju mučninu, povraćanje, uznemirenost, bol u trbuhu, lupanje srca, refraktorni šok, srčane aritmije, plućni edem, dispneju, cijanozu i osjetilne promjene. Dijagnoza se zasniva na kliničkom opažanju, pozitivnom nalazu testa na fosfin sa srebrnim nitratom, aspiratu iz želuca te biokemiji crijeva. Otkrije li se rano, liječenje obuhvaća ispiranje želuca kalijevim permanganatom, odnosno kombinacijom kokosova ulja i natrijeva bikarbonata, aktivni ugljen te palijativnu skrb. Usmjereno liječenje obuvhaća intravensku primjenu magnezijeva sulfata i kokosova ulja. Korisnim se može pokazati liječenje acidoze ranom intravenskom primjenom natrijeva bikarbonata i liječenje srčanoga šoka odgovarajućom tekućinom i vazopresorom te refraktornog šoka, intraaortalnim balonom odnosno digoksinom. Korisnim se može pokazati i trimetazidin, budući da sprječava ventrikularne ekstrasistole i bigeminiju te čuva oksidativni metabolizam. Ovaj članak donosi pregled različitih vidova trovanja aluminijevim fosfidom, uključujući njegovu epidemiologiju, toksičnost, kliničke znakove i simptome te medicinsku obradu.