What is the management approach for a patient with organophosphate poisoning?

Management of Celphos (Aluminum Phosphide) Poisoning

Critical Initial Recognition

Celphos poisoning is NOT organophosphate poisoning—it is aluminum phosphide poisoning that releases phosphine gas, and the management differs fundamentally from organophosphate protocols. While the evidence provided focuses on organophosphate management, Celphos requires specific interventions targeting cardiovascular collapse and metabolic acidosis rather than cholinergic crisis.

Immediate Life-Saving Interventions

Decontamination Protocol

• Remove all contaminated clothing and perform immediate gastric lavage with a mixture of coconut oil and sodium bicarbonate solution 1
• Use personal protective equipment (PPE) to prevent secondary exposure to healthcare workers 2
• Perform copious irrigation with soap and water for any dermal exposure 2

Airway and Respiratory Management

• Secure the airway early with endotracheal intubation for life-threatening presentations 2, 3
• Avoid succinylcholine and mivacurium for intubation as neuromuscular blockers metabolized by cholinesterase are contraindicated in any phosphorus-based poisoning 2, 3
• Provide aggressive respiratory support as pulmonary edema is common 1

Cardiovascular Support (Primary Cause of Death)

Hemodynamic Monitoring

• Implement strict invasive and non-invasive monitoring immediately upon ICU admission 1
• Target systolic blood pressure >80 mm Hg with aggressive fluid resuscitation 4
• Cardiovascular manifestations occur in 58% of Celphos cases and represent the leading cause of mortality 1

Vasopressor Support

• Elevate legs for hypotension as initial measure 5
• Prepare for early vasopressor therapy as cardiovascular collapse is rapid and severe 1

Metabolic Management

Acid-Base Correction

• Administer sodium bicarbonate solution both for gastric lavage and systemic metabolic acidosis correction 1
• Monitor arterial blood gases closely as metabolic acidosis develops rapidly 1

Electrolyte Monitoring

• Monitor creatinine kinase and potassium levels for rhabdomyolysis detection 2
• Provide adequate hydration and forced diuresis if rhabdomyolysis develops 2

Symptomatic Treatment

Seizure Control

• Administer benzodiazepines (diazepam or midazolam) for seizures and extreme agitation 2, 3
• Diazepam is first-line unless respiratory depression risk exists 5

Gastrointestinal Protection

• Cimetidine is commonly used (98.3% of poisoning cases) for gastric protection 6
• Proton pump inhibitors (72.5% of cases) and antiemetics (89.2% of cases) provide supportive care 6

Critical Pitfalls to Avoid

Do NOT Use Organophosphate Protocols

• Atropine and pralidoxime are NOT indicated for Celphos poisoning—these are specific antidotes for organophosphate/cholinesterase inhibitor poisoning 4, 2, 7
• Celphos does not cause cholinergic crisis; it causes direct cardiotoxicity and metabolic poisoning 1

Avoid Contraindicated Medications

• Do not use morphine, theophylline, aminophylline, reserpine, or phenothiazine-type tranquilizers 7
• Avoid ipecac syrup under any circumstances 5

Monitoring Duration

• Maintain close observation for at least 48-72 hours as delayed complications and relapses can occur 3, 7
• Mean ICU stay is 5.84±1.86 days for Celphos poisoning 1
• Continue monitoring for multi-organ symptomatology (18% of cases) including respiratory distress (15%) 1

Prognosis and Realistic Expectations

• With aggressive supportive care including coconut oil-sodium bicarbonate lavage, survival rate reaches 42% 1
• Celphos remains one of the most lethal poisonings with no specific antidote available 1
• Early presentation and immediate aggressive supportive care are the only factors that improve survival 1

Essential Concurrent Therapies

Antioxidant Support

• Antioxidants are recommended for managing phosphorus-based poisoning 8
• Consider novel adjunct therapies including magnesium sulfate for cellular protection 8

Psychological Assessment

• Evaluate risk of short-term relapse in self-poisoning cases (64.2% of poisoning cases are intentional) 6
• Mental disorders (20.8%), family disharmony (19.2%), and marital disharmony (15.8%) are the three most common causes of intentional poisoning 6
• Hospital admission should be maintained until acute suicide risk subsides 5