Management of Aluminum Phosphide (AlP) Poisoning
Aggressive supportive care is the cornerstone of management for aluminum phosphide poisoning as there is no specific antidote available. 1
Initial Management
- Ensure proper ventilation of treatment areas as phosphine gas released from AlP is highly toxic and can affect healthcare providers 2
- Perform gastric lavage with potassium permanganate (1:10,000 solution) to oxidize phosphine gas if patient presents within 1 hour of ingestion 1
- Consider administration of coconut oil to decrease absorption of phosphine gas 1
- Avoid physical restraints without adequate sedation as this can worsen outcomes 2
Respiratory Management
- Early endotracheal intubation is recommended for patients with respiratory distress, decreased level of consciousness, or severe metabolic acidosis 3
- Consider continuous positive airway pressure (CPAP) ventilation for patients with adequate consciousness and without contraindications 2
Cardiovascular Support
- Aggressive fluid resuscitation with crystalloids to manage hypotension and shock 3, 1
- Initiate vasopressors (norepinephrine preferred) for refractory hypotension 4
- Monitor ECG continuously for arrhythmias, particularly atrial fibrillation and ST segment changes 3, 5
- Consider magnesium sulfate administration to reduce cardiac arrhythmias, though dosing protocols vary 3
Metabolic Management
- Correct metabolic acidosis with sodium bicarbonate if severe (pH < 7.1) 1
- Monitor serum glucose levels as hyperglycemia is common 5
- Consider N-acetylcysteine administration as it may help reduce oxidative stress 4
Monitoring and Laboratory Investigations
- Perform serial arterial blood gas analyses to monitor acid-base status 4
- Monitor cardiac troponin levels to assess for myocardial injury 3
- Check serum electrolytes, particularly potassium and magnesium 2
- Monitor for rhabdomyolysis with serum creatinine kinase measurements 2
Management of Complications
- For myocardial injury, provide standard treatment for acute coronary syndrome 3
- For rhabdomyolysis, ensure adequate hydration and consider urine alkalinization 2
- For acute kidney injury, consider early renal replacement therapy if indicated 1
Prognostic Factors
- Poor prognostic factors include:
Special Considerations
- If aluminum toxicity is suspected (particularly in dialysis patients), measure serum aluminum levels 2
- For confirmed aluminum toxicity with levels >60μg/L but <200μg/L, consider deferoxamine (DFO) at 5 mg/kg 2
- Avoid administering DFO if serum aluminum levels are >200μg/L due to risk of neurotoxicity; instead, perform intensive dialysis 2
Pitfalls to Avoid
- Do not induce vomiting as this may increase risk of aspiration and further exposure to healthcare providers 1
- Avoid administering calcium channel blockers as they may worsen hypotension 1
- Do not delay supportive care while waiting for laboratory confirmation 5
- Remember that phosphine gas can cause spontaneous ignition in rare cases, so take appropriate precautions 6