Management of Celphos (Aluminum Phosphide) Poisoning
I must clarify that the evidence provided addresses organophosphate poisoning, NOT aluminum phosphide (Celphos) poisoning—these are entirely different toxicological entities requiring fundamentally different management approaches. Aluminum phosphide releases phosphine gas and causes severe cardiovascular collapse, metabolic acidosis, and multi-organ failure through mechanisms completely unrelated to cholinesterase inhibition.
Critical Distinction
Celphos (aluminum phosphide) poisoning does NOT respond to atropine, pralidoxime, or cholinesterase-based therapies. The provided guidelines 1 are specific to organophosphate compounds that inhibit acetylcholinesterase, while aluminum phosphide acts through phosphine gas generation causing direct cellular toxicity, mitochondrial dysfunction, and cardiovascular collapse.
Management Principles for Aluminum Phosphide Poisoning (Based on General Medical Knowledge)
Immediate Stabilization
- Ensure personal protective equipment and adequate ventilation as phosphine gas can harm healthcare providers through secondary exposure
- Secure airway early with endotracheal intubation for severe cases, as respiratory failure develops rapidly
- Aggressive fluid resuscitation with crystalloids for hypotension and shock
- Vasopressor support (norepinephrine, dopamine) is typically required for refractory hypotension
Specific Interventions
- Gastric lavage with potassium permanganate or sodium bicarbonate may be considered if presentation is within 1-2 hours to oxidize remaining phosphide
- Magnesium sulfate has been studied as adjunctive therapy for cardiac protection
- Sodium bicarbonate for severe metabolic acidosis
- N-acetylcysteine has been investigated for antioxidant effects
- Avoid gastric lavage with water alone as it may accelerate phosphine gas release
Monitoring and Supportive Care
- Continuous cardiac monitoring for dysrhythmias (ventricular tachycardia, heart block)
- Serial arterial blood gases to monitor metabolic acidosis
- Echocardiography to assess cardiac function
- Hemodialysis may be needed for renal failure but does not remove phosphine
Common Pitfalls
- Do NOT use organophosphate protocols (atropine, pralidoxime) as they are ineffective and waste critical time
- Do NOT delay supportive care while searching for specific antidotes—none exist with strong evidence
- Prognosis is poor with mortality rates of 40-100% depending on dose ingested
Key Takeaway
If you are treating actual Celphos/aluminum phosphide poisoning, contact your regional poison control center immediately (1-800-222-1222 in the US) as this is a highly lethal poisoning requiring expert guidance and primarily supportive care, not the cholinesterase-based therapies described in the provided organophosphate guidelines 1, 2, 3.