A review of aluminium phosphide poisoning and a flowchart to treat it

1. Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003;32:902-9. PMCID: PMC200128010.1093/ije/dyg307200128014681240Search in Google Scholar

2. Hassanian-Moghaddam H. Phosphides and phosphine: Mechanisms for toxicity and range of the problem. In: XXXIV International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT); 27-30 May 2014; Brussels, Belgium. Clin Toxicol 2014;52:397-8.Search in Google Scholar

3. Moghadamnia AA, Abdollahi M. An epidemiological study of poisoning in northern Islamic Republic of Iran. East Mediterr Health J 2002;8:88-94. PMID: 1533056410.26719/2002.8.1.88Search in Google Scholar

4. Bogle R, Theron P, Brooks P, Dargan P, Redhead J. Aluminium phosphide poisoning. Emerg Med J 2006;23:e3. doi: 10.1136/emj.2004.015941Search in Google Scholar

5. Gargi J, Rai H, Chanana A, Rai G, Sharma G, Bagga I. Current trends of poisoning-a hospital profile. J Indian Med Assoc 2006;104:72-3, 94. PMID: 16856585Search in Google Scholar

6. Goel A, Aggarwal P. Pesticide poisoning. Natl Med J India 2007;20:182-91. PMID: 18085124Search in Google Scholar

7. Murali R, Bhalla A, Singh D, Singh S. Acute pesticide poisoning: 15 years experience of a large North-West Indian hospital. Clin Toxicol (Phila). 2009;47:35-8. doi: 10.1080/15563650701885807Search in Google Scholar

8. Shadnia S, Sasanian G, Allami P, Hosseini A, Ranjbar A, Amini-Shirazi N, Abdollahi M. A retrospective 7-years study of aluminum phosphide poisoning in Tehran: opportunities for prevention. Hum Exp Toxicol 2009;28:209-13. doi: 10.1177/0960327108097194Search in Google Scholar

9. Nocera A, Levitin HW, Hilton J. Dangerous bodies: a case of fatal aluminium phosphide poisoning. Med J Aust 2000;173:133-5. PMID: 1097937810.5694/j.1326-5377.2000.tb125567.xSearch in Google Scholar

10. Popp W, Mentfewitz J, Götz R, Voshaar T. Phosphine poisoning in a German office. Lancet 2002;359:1574. doi: 10.1016/S0140-6736(02)08518-5Search in Google Scholar

11. Lauterbach M, Solak E, Kaes J, Wiechelt J, Von Mach M-A, Weilemann L. Epidemiology of hydrogen phosphide exposures in humans reported to the poison center in Mainz, Germany, 1983-2003. Clin Toxicol (Phila) 2005;43:575-81. PMID: 1625534010.1081/CLT-200068847Search in Google Scholar

12. Mehrpour O, Singh S. Rice tablet poisoning: a major concern in Iranian population. Hum Exp Toxicol 2010;29:701-2. doi: 10.1177/0960327109359643Search in Google Scholar

13. Hosseinian A, Pakravan N, Rafiei A, Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: a common toxicity in North Iran. Indian J Med Sci 2011;65:143-9. doi: 10.4103/0019-5359.104777Search in Google Scholar

14. Hassanian-Moghaddam H, Pajoumand A. Two years epidemiological survey of aluminum phosphide poisoning in Tehran. Iranian J Toxicol 2007;1:35-9.Search in Google Scholar

15. Nosrati A, Karami M, Esmaeilnia M. Aluminum phosphide poisoning: a case series in North Iran. Asia Pac J Med Toxicol 2013;2:111-3.Search in Google Scholar

16. Fumigation (phosphine) explosions. UK P&I Club [bulletin] 2003;(289). [displayed 9 July 2016]. Available at http://www.ukpandi.com/knowledge/article/289-02-03-fumigationphosphine-explosions-1539/10.1142/S0219649203000346Search in Google Scholar

17. Shadnia S, Soltaninejad K. Spontaneous ignition due to intentional acute aluminum phosphide poisoning. J Emerg Med 2011;40:179-81. doi: 10.1016/j.jemermed.2009.05.028Search in Google Scholar

18. Wahab A, Rabbani MU, Wahab S, Khan RA. Spontaneous self-ignition in a case of acute aluminium phosphide poisoning. Am J Emerg Med 2009;27:752. e5-6. doi: 10.1016/j.ajem.2008.09.045Search in Google Scholar

19. Yadav J, Athawal BK, Dubey BP, Yadav VK. Spontaneous ignition in case of celphos poisoning. Am J Forensic Med Pathol 2007;28:353-5. doi: 10.1097/PAF.0b013e31815b4bedSearch in Google Scholar

20. NIOSH, ALERT. Preventing Phosphine Poisoning and Explosions during Fumigation [displayed 10 August 2016]. Available at https://www.cdc.gov/niosh/docs/99-126/pdfs/99-126.pdfSearch in Google Scholar

21. Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2012;63:61-73. doi: 10.2478/10004-1254-63-2012-2182Search in Google Scholar

22. Pepelko B, Seckar J, Harp PR, Kim JH, Gray D, Anderson EL. Worker exposure standard for phosphine gas. Risk Anal 2004;24:1201-13. doi: 10.1111/j.0272-4332.2004.00519.xSearch in Google Scholar

23. International Program on Chemical Safety (IPCS). Phosphine (PIM 865). Poisons information monograph [displayed 10 August 2016]. Available at http://www.inchem.org/documents/pims/chemical/pim865.htmSearch in Google Scholar

24. Anger F, Paysant F, Brousse F, Le Normand I, Develay P, Galliard Y, Baert A, Le Gueut MA, Pepin G, Anger JP. Fatal aluminum phosphide poisoning. J Anal Toxicol 2000;24:90-2. PMID: 1073294510.1093/jat/24.2.9010732945Search in Google Scholar

25. Mehrpour O, Alfred S, Shadnia S, Keyler D, Soltaninejad K, Chalaki N, Sedaghat M. Hyperglycemia in acute aluminum phosphide poisoning as a potential prognostic factor. Hum Exp Toxicol 2008;27:591-5. doi: 10.1177/0960327108096382Search in Google Scholar

26. Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock 2011;4:378-84. doi: 10.4103/0974-2700.83868Search in Google Scholar

27. Dua R, Gill KD. Effect of aluminium phosphide exposure on kinetic properties of cytochrome oxidase and mitochondrial energy metabolism in rat brain. Biochim Biophys Acta 2004;1674:4-11. doi: 10.1016/j.bbagen.2004.05.003Search in Google Scholar

28. Singh S, Bhalla A, Verma SK, Kaur A, Gill K. Cytochrome-C oxidase inhibition in 26 aluminum phosphide poisoned patients. Clin Toxicol (Phila) 2006;44:155-8. doi: 10.1080/15563650500514467Search in Google Scholar

29. Hsu C-H, Chi B-C, Liu M-Y, Li J-H, Chen C-J, Chen R-Y. Phosphine-induced oxidative damage in rats: role of glutathione. Toxicology 2002;179:1-8. doi: 10.1016/S0300-483X(02)00246-9Search in Google Scholar

30. Lall SB, Peshin S, Mitra S. Methemoglobinemia in aluminium phosphide poisoning in rats. Idian J Exp Biol 2000;38:95-7. PMID: 11233095Search in Google Scholar

31. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol( Phila) 2009; 47: 89 - 100. doi: 10.1080/15563650802520675 Search in Google Scholar

32. Anand R, Binukumar BK, Gill KD. Aluminum phosphide poisoning: an unsolved riddle. J Appl Toxicol 2011;31:499-505. doi: 10.1002/jat.1692Search in Google Scholar

33. Mittra S, Peshin S, Lall S. Cholinesterase inhibition by aluminium phosphide poisoning in rats and effects of atropine and pralidoxime chloride. Acta Pharmacol Sin 2001;22:37-9. PMID: 11730559Search in Google Scholar

34. Shadnia S, Soltaninejad K, Hassanian-Moghaddam H, Sadeghi A, Rahimzadeh H, Zamani N, Ghasemi-Toussi A, Abdollahi M. Methemoglobinemia in aluminum phosphide poisoning. Hum Exp Toxicol 2011;30:250-3. doi: 10.1177/0960327110384287Search in Google Scholar

35. Mashayekhian M, Hassanian-Moghaddam H, Rahimi M, Zamani N, Aghabiklooei A, Shadnia S. Elevated carboxyhemoglobin concentrations by pulse CO-oximetry is associated with severe aluminium phosphide poisoning. Basic Clin Pharmacol Toxicol 2016;119:322-9. doi: 10.1111/ bcpt.12571Search in Google Scholar

36. Moazezi Z, Abedi SH. A successful management of aluminum phosphide intoxication. Caspian J Int Med 2011;2:286-8. PMCID: PMC3770497Search in Google Scholar

37. Moghadamnia AA. An update on toxicology of aluminum phosphide. Daru 2012;20:25. doi: 10.1186/2008-2231-20-25Search in Google Scholar

38. Sudakin D. Occupational exposure to aluminium phosphide and phosphine gas? A suspected case report and review of the literature. Hum Exp Toxicol 2005;24:27-33. doi: 10.1191/0960327105ht496oaSearch in Google Scholar

39. Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning. Indian J Med Sci 2009;63:227-34. doi: 10.4103/0019-5359.53386Search in Google Scholar

40. Frangides CY, Pneumatikos IA. Persistent severe hypoglycemia in acute zinc phosphide poisoning. Intensive Care Med 2002;28:223. doi: 10.1007/s00134-001-1164-7Search in Google Scholar

41. Akkaoui M, Achour S, Abidi K, Himdi B, Madani A, Zeggwagh AA, et al. Reversible myocardial injury associated with aluminum phosphide poisoning. Clin Toxicol (Phila) 2007;45:728-31. doi: 10.1080/15563650701517350Search in Google Scholar

42. Bayazıt AK, Noyan A, Anarat A. A child with hepatic and renal failure caused by aluminum phosphide. Nephron 2000;86:517. doi: 10.1159/000045849Search in Google Scholar

43. Memiş D, Tokatlıoglu D, Koyuncu O, Hekimoglu S. Fatal aluminium phosphide poisoning. Eur J Anaesthesiol 2007;24(03):292-3.10.1017/S026502150600145117054805Search in Google Scholar

44. Saleki S, Ardalan FA, Javidan-Nejad A. Liver histopathology of fatal phosphine poisoning. Forensic Sci Int 2007;166:190-3. doi: 10.1016/j.forsciint.2006.05.033Search in Google Scholar

45. Kaushik RM, Kaushik R, Mahajan SK. Subendocardial infarction in a young survivor of aluminium phosphide poisoning. Hum Exp Toxicol 2007;26:457-60. doi: 10.1177/0960327107074618Search in Google Scholar

46. Mehrpour O, Farzaneh E, Abdollahi M. Successful treatment of aluminum phosphide poisoning with digoxin: A case report and review of literature. Int J Pharmacol 2011;7:761-4. doi: 10.3923/ijp.2011.761.764Search in Google Scholar

47. Alter P, Grimm W, Maisch B. Lethal heart failure caused by aluminium phosphide poisoning. Intensive Care Med 2001;27:327. PMID: 1128066410.1007/s00134000074411280664Search in Google Scholar

48. Mehrpour O, Shadnia S, Soltaninejad K, Yaghmaei A. Evaluation of electrolytes and blood glucose level in aluminum phosphide poisoning. Sci J Forensic Med 2009;15:49-53.Search in Google Scholar

49. Chugh S, Kishore K, Aggarwal N, Attri S. Aluminium phosphide (ALP) is a widely used fumigant posticide. J Assoc Physicians India 2000;48:855-6. PMID: 11273495Search in Google Scholar

50. Shadnia S, Mehrpour O, Abdollahi M. Unintentional poisoning by phosphine released from aluminum phosphide. Hum Exp Toxicol 2008; 27: 87 - 9. doi: 10.1177/0960327107086241Search in Google Scholar

51. Verma S, Ahmad S, Shirazi N, Barthwal S, Khurana D, Chugh M, Gambhir HS. Acute pancreatitis: A lesser-known complication of aluminum phosphide poisoning. Hum Exp Toxicol 2007;26:979-81. doi: 10.1177/0960327107087793Search in Google Scholar

52. Jain RK, Gouda NB, Sharma VK, Dubey TN, Shende A, Malik R, Tiwari G. Esophageal complications following aluminium phosphide ingestion: An emerging issue among survivors of poisoning. Dysphagia 2010;25:271-6. doi: 10.1007/s00455-009-9251-ySearch in Google Scholar

53. Madan K, Chalamalasetty SB, Sharma M, Makharia G. Corrosive-like strictures caused by ingestion of aluminium phosphide. Natl Med J India 2006;19:313-4. PMID: 17343015Search in Google Scholar

54. Verma R, Gupta S, Bahl D, Gupta A. Aluminium phosphide poisoning: late presentation as oesophageal stricture. JK Sci 2006;8:235-6.Search in Google Scholar

55. Okolie NP, Aligbe JU, Osakue EE. Phostoxin-induced biochemical and pathomorphological changes in rabbits. Indian J Exp Biol 2004;42:1096-9. PMID: 15587116Search in Google Scholar

56. Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol 2005;24:279-85. doi: 10.1191/0960327105ht527oaSearch in Google Scholar

57. Chugh SN, Kishore K, Aggarwal N, Attri S. Hypoglycemia in acute aluminium phosphide poisoning. J Assoc Physicians India 2000;48:855-6.Search in Google Scholar

58. Khurana V, Gambhir I, Kishore D. Microangiopathic hemolytic anemia following disseminated intravascular coagulation in aluminum phosphide poisoning. Indian J Med Sci 2009;63:257-9. doi: 10.4103/0019-5359.53396Search in Google Scholar

59. Soltaninejad K, Nelson LS, Khodakarim N, Dadvar Z, Shadnia S. Unusual complication of aluminum phosphide poisoning: Development of hemolysis and methemoglobinemia and its successful treatment. Indian J Crit Care Med 2011;15:117-9. doi: 10.4103/0972-5229.83021Search in Google Scholar

60. Mehrpour O, Dolati M, Soltaninejad K, Shadnia S, Nazparvar B. Evaluation of histopathological changes in fatal aluminum phosphide poisoning. Indian J Forensic Med Toxicol 2008;2:34-6.Search in Google Scholar

61. Soltaninejad K, Beyranvand M-R, Momenzadeh S-A, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. J Forensic Leg Med 2012;19:291-3. doi: 10.1016/j. jflm.2012.02.005Search in Google Scholar

62. Hassanian-Moghaddam H, Zamani N. Therapeutic role of hyperinsulinemia/euglycemia in aluminum phosphide poisoning. Medicine 2016;95(31):e4349.10.1097/MD.0000000000004349497979427495040Search in Google Scholar

63. Soltaninejad K, Shadnia S, Ziyapour B, Brent J. Aluminum phosphide intoxication mimicking ischemic heart disease led to unjustified treatment with streptokinase. Clin Toxicol (Phila) 2009;47:908-9. doi: 10.3109/15563650903285657Search in Google Scholar

64. National Research Council (US) Committee on Acute Exposure Guideline Levels. Phosphine and eight metal phosphides. In: Acute exposure guideline levels for delected airborne chemicals. Vol. 6. Washington (DC): National Academics Press; 2008. p. 73.Search in Google Scholar

65. Chan LT, Crowley RJ, Delliou D, Geyer R. Phosphine analysis in post mortem specimens following ingestion of aluminium phosphide. J Anal Toxicol 1983 Jul- Aug;7(4):165-7.10.1093/jat/7.4.1656314042Search in Google Scholar

66. Hassanian-Moghaddam H, Shahnazi M, Zamani N, Bahrami- Motlagh H. Abdominal imaging in zinc phosphide poisoning. Emerg Radiol 2014;21:329-31. doi: 10.1007/s10140-014-1195-3Search in Google Scholar

67. Hassanian-Moghaddam H, Shahnazi M, Zamani N, Rahimi M, Bahrami-Motlagh H, Amiri H. Plain abdominal radiography: A powerful tool to prognosticate outcome in patients with zinc phosphide poisoning. Clin Radiol 2014;69:1062-5. doi: 10.1016/j.crad.2014.06.003Search in Google Scholar

68. Maitai C, Njoroge D, Abuga K, Mwaura A, Munenge R. Investigation of possible antidotal effects of activated charcoal, sodium bicarbonate, hydrogen peroxide and potassium permanganate in zinc phosphide poisoning. East Central Afr J Pharm Sci 2004;5:38-41. doi: 10.4314/ecajps. v5i2.9686Search in Google Scholar

69. Jalali N, Shadnia S, Abdofiahi M, Pajoumand A. Survival following severe aluminium phosphide poisoning. J Pharm Pract Res 2002;32:297-9. doi: 10.1002/jppr2002324297Search in Google Scholar

70. Shadnia S, Rahimi M, Pajoumand A, Rasouli M-H, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Hum Exp Toxicol 2005;24:215-8. PMID: 1595753810.1191/0960327105ht513oa15957538Search in Google Scholar

71. Saidi H, Shojaie S. Effect of sweet almond oil on survival rate and plasma cholinesterase activity of aluminum phosphide-intoxicated rats. Hum Exp Toxicol 2012;31:518-22. doi: 10.1177/0960327111407229Search in Google Scholar

72. Hassanian-Moghaddam H, Shahbazi A. Gastric ventilation: a new approach to metal phosphide fumigant ingestion. Clin Toxicol( Phila) 2012; 50: 435 - 7. doi: 10.3109/15563650.2012.676648Search in Google Scholar

73. Sanaei-Zadeh H, Farajidana H. Is there a role for digoxin in the management of acute aluminum phosphide poisoning? Med Hypotheses 2011;76:765-6. doi: 10.1016/j. mehy.2011.02.023Search in Google Scholar

74. Mehrpour O, Amouzeshi A, Dadpour B, Oghabian Z, Zamani N, Amini S, Hoffman RS. Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Arh Hig Rada Toksikol 2014;65:121-7. doi: 10.2478/10004-1254-65-2014-2393Search in Google Scholar

75. Hassanian-Moghaddam H, Zamani N, Rahimi M, Hajesmaeili M, Taherkhani M, Sadeghi R. Successful treatment of aluminium phosphide poisoning by extracorporeal membrane oxygenation. Basic Clin Pharmacol Toxicol 2016;118:243-6. doi: 10.1111/bcpt.12481Search in Google Scholar

76. Baud FJ, Megarbane B, Deye N, Leprince P. Clinical review: aggressive management and extracorporeal support for druginduced cardiotoxicity. Crit Care 2007;11:207. doi: 10.1186/ cc5700Search in Google Scholar

77. Wiki Tox - Open Source Clinical Toxicology Curriculum. Phosphorus and phosphides. Phosphides/Phosphine gas [displayed 10 August 2016]. Avalable at http://curriculum.toxicology.wikispaces.net/2.2.10.30+Phosphorus+and+phosphidesSearch in Google Scholar

78. Azad A, Lall S, Mittra S. Effect of N-acetylcysteine and L-NAME on aluminium phosphide induced cardiovascular toxicity in rats. Acta Pharmacol Sin 2001;22:298-304. PMID: 11742581Search in Google Scholar

79. Tehrani H, Halvaie Z, Shadnia S, Soltaninejad K, Abdollahi M. Protective effects of N-acetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning. Clin Toxicol (Phila) 2013;51:23-8. doi: 10.3109/15563650.2012.743029Search in Google Scholar

80. Agarwal A, Robo R, Jain N, Gutch M, Consil S, Kumar S. Oxidative stress determined through the levels of antioxidant enzymes and the effect of N-acetylcysteine in aluminum phosphide poisoning. Indian J Crit Care Med 2014;18:666-71. doi: 10.4103/0972-5229.142176Search in Google Scholar

81. Saidi H, Shokraneh F, Ghafouri H-B, Shojaie S. Effects of hyperbaric oxygenation on survival time of aluminum phosphide intoxicated rats. J Res Med Sci 2011;16:1306-12. PMCID: PMC3430020Search in Google Scholar

82. Marashi SM, Arefi M, Behnoush B, Nasrabad MG, Nasrabadi ZN. Could hydroxyethyl starch be a therapeutic option in management of acute aluminum phosphide toxicity? Med Hypotheses 2011;76:596-8. doi: 10.1016/j.mehy.2011.01.009Search in Google Scholar

83. Zamani N, Mehrpour O. Protective role of G6PD deficiency in poisoning by aluminum phosphide; are there possible new treatments? Eur Rev Med Pharmacol Sci 2013;17:994-5. PMID: 23640450Search in Google Scholar

84. Wahab A, Zaheer M, Wahab S, Khan R. Acute aluminium phosphide poisoning: an update. Hong Kong J Emerg Med 2008;15:152-5.10.1177/102490790801500306Search in Google Scholar

85. Shadnia S, Mehrpour O, Soltaninejad K. A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome. Indian J Med Sci 2010;64:532-9. doi: 10.4103/0019-5359.75928Search in Google Scholar

86. Mostafazadeh B, Pajoumand A, Farzaneh E, Aghabiklooei A, Rasouli MR. Blood levels of methemoglobin in patients with aluminum phosphide poisoning and its correlation with patient’s outcome. J Med Toxicol 2011;7:40-3. doi: 10.1007/ s13181-010-0121-7Search in Google Scholar

87. Alizadeh AM, Hassanian-Moghaddam H, Shadnia S, Zamani N, Mehrpour O. Simplified acute physiology score II/acute physiology and chronic health evaluation II and prediction of the mortality and later development of complications in poisoned patients admitted to intensive care unit. Basic Clin Pharmacol Toxicol 2014;115:297-300. doi: 10.1111/ bcpt.12210Search in Google Scholar

88. Bhargava S, Rastogi R, Agarwal A, Jindal G. Esophagobronchial fistula-A rare complication of aluminum phosphide poisoning. Ann Thorac Med 2011;6:41-2. doi: 10.4103/1817-1737.74276Search in Google Scholar

89. Levels of Evidence and grades of recommendation: SIGN [displayed 11 August 2016]. Available at http://www.guiasalud.es/egpc/traduccion/ingles/parto_normal/completa/documentos/apartado00/levels_of_evidence.pdfSearch in Google Scholar

90. Krishan Vij. Textbook of forensic medicine and toxicology: Principles and practice. 5th ed. Chapter 44. Fumigants. New Delhi: Elsevier, a division of Reed Elsevier India Private Limited; 2014. p. 541-5.Search in Google Scholar