What is the treatment for aluminium phosphide poisoning?

Treatment of Aluminum Phosphide Poisoning

The treatment of aluminum phosphide poisoning requires immediate supportive care with a focus on cardiovascular support, as there is no specific antidote available. 1

Initial Management

• Decontamination:

  • Remove contaminated clothing
  • Thoroughly wash skin and hair with soap and water
  • Use personal protective equipment (respiratory protection, gloves, gowns, eye protection) to prevent secondary exposure 1

• Immediate Resuscitation:

  • Secure airway, breathing, and circulation
  • Aggressive fluid resuscitation to manage hypotension
  • Early intubation if respiratory distress or decreased consciousness

Cardiovascular Support

• Vasopressors/Inotropes:

  • Norepinephrine and dopamine for refractory shock 2
  • Consider multiple vasopressors if single agent is ineffective

• Antiarrhythmic Therapy:

  • Magnesium sulfate for ventricular arrhythmias 3, 4
  • Lidocaine as alternative for ventricular arrhythmias 3

• Advanced Cardiovascular Support:

  • Consider veno-arterial extracorporeal membrane oxygenation (ECMO) in severe cases with cardiogenic shock 3
  • Intra-aortic balloon pump may be considered in centers where available 4

Management of Metabolic Derangements

• Metabolic Acidosis:
  • Sodium bicarbonate administration for severe metabolic acidosis 2
  • Continuous renal replacement therapy (CRRT) or hemodialysis for persistent severe acidosis 3, 2

Adjunctive Therapies

• Antioxidant Therapy:

  • N-acetylcysteine (NAC) as a free radical scavenger 4, 5
  • Coenzyme Q10 for cardioprotection 5
  • Consider vitamin C, thiamine, and hydrocortisone 4

• Membrane Stabilizers:

  • Magnesium sulfate (1-2 g IV initially, followed by infusion) 4
  • Trimetazidine as cardioprotective agent 4

Monitoring and Supportive Care

• Continuous Monitoring:

  • Cardiac monitoring for arrhythmias
  • Frequent vital signs assessment
  • Serial arterial blood gases and electrolytes
  • Liver and kidney function tests

• Organ Support:

  • Mechanical ventilation for respiratory failure 5
  • Renal replacement therapy for acute kidney injury 3
  • Manage hepatic dysfunction supportively

Important Considerations

• Aluminum phosphide poisoning has a high mortality rate (30-77%) due to multiorgan failure 3
• Early transfer to a tertiary care center with ECMO and CRRT capabilities is recommended for suspected cases 3
• The combination of NAC and CoQ10 has shown promise in improving survival rates (73.3% vs 50% with standard care) and reducing need for mechanical ventilation 5
• The toxicity mechanism involves phosphine gas release when aluminum phosphide contacts moisture, leading to mitochondrial dysfunction and oxidative stress 6

Pitfalls to Avoid

• Delaying treatment while waiting for laboratory confirmation
• Inadequate cardiovascular support in the early phase
• Using succinylcholine or mivacurium for intubation (may cause prolonged paralysis)
• Failure to recognize and treat multiorgan failure
• Not using personal protective equipment when managing these patients

Remember that early, aggressive supportive care with a focus on cardiovascular support is the cornerstone of management for aluminum phosphide poisoning.