Aluminum phosphide poisoning

Abstract

Letter to Editor Aluminum phosphide poisoning Dear Editor, Aluminum phosphide, is a fumigant with high insecticide power in all life stages of insects, which is harmful in stored products. It is in the form of tablets or granules and is highlylethal and has no antidote. It inhibits the enyzme of cytochrome oxidase. Complications may develop as a result of inhaling phosphine gas or oral intake. Respiratory, circulatory, gastrointestinal tract andnervous system, kidney and liver may be affected. Shock, ARDS, aspration pnomony, anemia, metabolic acidosis, electrolytic disorder, coma, hipoxy, hemorrhage, pericardide are poorprognosis criterion. Leukopenia indicates severe toxicity. The lethal dose is 0.15-0.5 g and death is inevitableeven when buying 3-5 tablets Arrhythmia is responsible for death in the first 24 hours.The mortality rate varies between 37-100%.Treatment consists entirely of supportive treatment. (liquid, dopamine, oxygen, mechanical ventilation, gastric washing, activated charcoal,bicarbonate, hemodialysis)We aimed to present the case that developedsystemic complications in follow-up but wedischarged with healing as a result of appropriatefollow-up and treatment. CASE A 16-year old female patient was rushed to theemergency room two hours ago for drinking morethan she knew the amount of the drug containing aluminum phosphide for suicidal purposes. When the patient arrived, his general condition wasmoderate, conscious, pale sweaty appearance and Tachypnea, BREATHING:26/min, TA:60/40mmhg,Pulse:135/min,,fever:37 degree systemic examination showed no abnormalities. Initial blood values, ECG and chest x-ray were normal. The patient was followed up in the emergency department. 1000ml serum physiological started In order to reduce the formation of phosphine gas(with alkalısm), oral bicarbonate was started. Ta:100/70mmHg in the 2nd hour of follow-up andchest pain developed. The first TROPONIN I value was:0.02(0-0.06 ng/ml). In echocardiography, ejection fraction wasdetermined 57%. In the blood gas, PH was 7.32 and there was metabolic acidosis. Her acidosis level improved in the 6th hour of the follow up. The control TROPONİN value was 0.21. Asetilsalisilik acid started at 100 mg. At the 12th hour white blood cell (4-11 k/ml) decreased from 12000 to 4000.However no abnormality was detected in other hemogram values. At the 20th hour ,her chest pain gone and her troponin values increased up to 1.45.No ECG change detected.Her acidose improved and lokopenia not seen.The patient’s control , liver and kidney function tests and ECHO were normal.No abnormality was detected in the follow ups , polyclinic controls and laboratory values on the third day of the hospitalization. The patient was discharged from the hospital with suggestions. Aluminum phosphide is an extremely mortal toxic substance.During the follow ups unwanted complications can develop. Merely satisfactory results can be achieved with valid , timely and appropriate supportive treatments

Keywords

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Aluminyum fosfit zehirlenmesi

Abstract

Letter to Editor Aluminum phosphide poisoning Dear Editor, Aluminum phosphide, is a fumigant with high insecticide power in all life stages of insects, which is harmful in stored products. It is in the form of tablets or granules and is highlylethal and has no antidote. It inhibits the enyzme of cytochrome oxidase. Complications may develop as a result of inhaling phosphine gas or oral intake. Respiratory, circulatory, gastrointestinal tract andnervous system, kidney and liver may be affected. Shock, ARDS, aspration pnomony, anemia, metabolic acidosis, electrolytic disorder, coma, hipoxy, hemorrhage, pericardide are poorprognosis criterion. Leukopenia indicates severe toxicity. The lethal dose is 0.15-0.5 g and death is inevitableeven when buying 3-5 tablets Arrhythmia is responsible for death in the first 24 hours.The mortality rate varies between 37-100%.Treatment consists entirely of supportive treatment. (liquid, dopamine, oxygen, mechanical ventilation, gastric washing, activated charcoal,bicarbonate, hemodialysis)We aimed to present the case that developedsystemic complications in follow-up but wedischarged with healing as a result of appropriatefollow-up and treatment. CASE A 16-year old female patient was rushed to theemergency room two hours ago for drinking morethan she knew the amount of the drug containing aluminum phosphide for suicidal purposes. When the patient arrived, his general condition wasmoderate, conscious, pale sweaty appearance and Tachypnea, BREATHING:26/min, TA:60/40mmhg,Pulse:135/min,,fever:37 degree systemic examination showed no abnormalities. Initial blood values, ECG and chest x-ray were normal. The patient was followed up in the emergency department. 1000ml serum physiological started In order to reduce the formation of phosphine gas(with alkalısm), oral bicarbonate was started. Ta:100/70mmHg in the 2nd hour of follow-up andchest pain developed. The first TROPONIN I value was:0.02(0-0.06 ng/ml). In echocardiography, ejection fraction wasdetermined 57%. In the blood gas, PH was 7.32 and there was metabolic acidosis. Her acidosis level improved in the 6th hour of the follow up. The control TROPONİN value was 0.21. Asetilsalisilik acid started at 100 mg. At the 12th hour white blood cell (4-11 k/ml) decreased from 12000 to 4000.However no abnormality was detected in other hemogram values. At the 20th hour ,her chest pain gone and her troponin values increased up to 1.45.No ECG change detected.Her acidose improved and lokopenia not seen.The patient’s control , liver and kidney function tests and ECHO were normal.No abnormality was detected in the follow ups , polyclinic controls and laboratory values on the third day of the hospitalization. The patient was discharged from the hospital with suggestions. Aluminum phosphide is an extremely mortal toxic substance.During the follow ups unwanted complications can develop. Merely satisfactory results can be achieved with valid , timely and appropriate supportive treatments

References

1. Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. Journal of emergencies, trauma and shock. 2011;4(3):378.
2. Bogle R, Theron P, Brooks P, Dargan P, Redhead J. Aluminium phosphide poisoning. Emergency Medicine Journal. 2006;23(1):3-7.
3. Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arhiv za higijenu rada i toksikologiju. 2012;63(1):61.