Gastric Lavage in Celphos (Aluminum Phosphide) Poisoning
Gastric lavage is NOT routinely recommended for celphos poisoning based on current toxicology guidelines, but if performed in exceptional circumstances within 60 minutes of ingestion, it should use a coconut oil and sodium bicarbonate mixture rather than standard saline. 1, 2
Evidence Against Routine Gastric Lavage
The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists position statements clearly establish that gastric lavage should not be employed routinely in poisoned patients. 1, 2 The evidence shows:
- Gastric lavage is associated with serious complications and has no proven benefit in improving clinical outcomes in poisoned patients. 1, 2
- The amount of toxin removed by gastric lavage is highly variable and diminishes rapidly with time after ingestion. 2
- Even when performed within 60 minutes of ingestion of a potentially life-threatening poison, clinical benefit has not been confirmed in controlled studies. 2
Special Considerations for Celphos Poisoning
Celphos (aluminum phosphide) differs from typical organophosphate pesticides—it is NOT an acetylcholinesterase inhibitor. 3 This is a critical distinction that affects management:
- Aluminum phosphide releases phosphine gas upon contact with moisture, causing direct cellular toxicity through mitochondrial dysfunction and cardiovascular collapse. 4
- Standard organophosphate antidotes (atropine and pralidoxime) are NOT indicated for aluminum phosphide poisoning. 3
Modified Lavage Protocol (If Performed)
If gastric lavage is considered in the rare circumstance of recent massive ingestion (within 60 minutes), one observational study suggests using a mixture of coconut oil and sodium bicarbonate solution rather than standard saline. 4 This study reported:
- A 42% survival rate using extensive gastric lavage with coconut oil and sodium bicarbonate mixture in 33 patients. 4
- The theoretical rationale is that coconut oil may coat pellets and sodium bicarbonate may reduce phosphine gas generation. 4
However, this evidence has significant limitations:
- Single-center observational study without controls. 4
- No comparison to supportive care alone. 4
- The 42% survival rate may reflect patient selection rather than treatment efficacy. 4
Recommended Management Algorithm
For celphos poisoning, prioritize the following over gastric lavage:
Immediate supportive care with aggressive hemodynamic monitoring and support (invasive and non-invasive monitoring). 4
Early intubation for airway protection if the patient shows signs of respiratory compromise or altered mental status. 3, 5
Cardiovascular support as the majority of patients (58%) present with cardiovascular manifestations including hypotension and arrhythmias. 4
Prolonged ICU monitoring for at least 48-72 hours, as the mean ICU stay is approximately 6 days. 4, 6
Contact poison control (1-800-222-1222 in the United States) for expert guidance on case-specific management. 6
Critical Pitfalls to Avoid
- Do NOT administer atropine or pralidoxime as these are specific for organophosphate cholinesterase inhibitors, not aluminum phosphide. 3
- Do NOT perform gastric lavage if airway protective reflexes are compromised unless the patient is intubated. 2
- Do NOT delay supportive care while attempting decontamination procedures. 1, 2
- Do NOT assume standard organophosphate protocols apply to aluminum phosphide poisoning despite the "celphos" name suggesting pesticide poisoning. 3
Contraindications to Gastric Lavage
Gastric lavage is absolutely contraindicated if: 2
- Airway protective reflexes are lost (unless patient is intubated)
- More than 60 minutes have elapsed since ingestion
- The patient is hemodynamically unstable
In summary, focus on aggressive supportive care and cardiovascular stabilization rather than gastric lavage for celphos poisoning, as no decontamination method has proven mortality benefit and the primary pathophysiology is direct cellular toxicity rather than systemic absorption. 4, 1, 2