Treatment for Aluminum Phosphide Poisoning
The management of aluminum phosphide poisoning is primarily supportive as there is no specific antidote, focusing on early gastric decontamination, hemodynamic support, and addressing multi-organ failure. 1, 2, 3
Initial Management
- Ensure proper ventilation of treatment areas as phosphine gas released from AlP is highly toxic and can affect healthcare providers 4
- Perform gastric lavage with diluted potassium permanganate, coconut oil, and sodium bicarbonate to reduce further absorption 1
- Avoid physical restraints without adequate sedation as this can worsen outcomes 4, 5
Respiratory Support
- Consider continuous positive airway pressure (CPAP) ventilation for patients with adequate consciousness and without contraindications 4
- Mechanical ventilation may be necessary for patients with respiratory failure 6
- High-flux dialysis membranes may be beneficial if available 4
Cardiovascular Support
- Aggressive fluid resuscitation to manage hypotension and shock 1, 6
- Inotropic support for refractory shock and hemodynamic instability 1, 6
- Intravenous magnesium sulfate for membrane stabilization and potential cardioprotective effects 7, 1
Management of Multi-organ Failure
- Monitor for and treat rhabdomyolysis with adequate hydration and urine alkalinization if myoglobinuria develops 4
- Regular monitoring of serum creatinine kinase and potassium to detect rhabdomyolysis 4
- Address metabolic acidosis with appropriate fluid and electrolyte management 6
Adjunctive Therapies
- Consider cardioprotective agents such as:
Aluminum Toxicity Management
- Measure serum aluminum levels if aluminum toxicity is suspected, particularly in dialysis patients 4
- For confirmed aluminum toxicity with levels >60μg/L but <200μg/L, administer deferoxamine (DFO) at 5 mg/kg 4
- Avoid administering DFO if serum aluminum levels are >200μg/L due to risk of neurotoxicity; instead, perform intensive dialysis 4, 8
- Be aware that DFO treatment can precipitate acute aluminum neurotoxicity and potentially fatal mucormycosis 8
Monitoring and Follow-up
- Intensive cardiac monitoring for arrhythmias and ECG abnormalities 3, 6
- Regular assessment of liver and kidney function 6
- Monitor for metabolic acidosis and correct as needed 6
Pitfalls and Caveats
- Delayed presentation (>2 hours) significantly worsens prognosis; early intervention is critical 3, 6
- AlP poisoning has a mortality rate of 70-100%, even with appropriate management 7, 2
- One tablet of AlP (approximately 3 grams) can be lethal 6
- The toxicity mechanism involves phosphine gas release upon contact with stomach acid, causing cellular hypoxia through inhibition of oxidative phosphorylation 1, 2
- Mitochondrial damage appears to be the primary mechanism of toxicity, leading to low ATP production and metabolic shutdown 2