Indian Journal of Anaesthesia

COMMENTS ON PUBLISHED ARTICLE
Year
: 2015  |  Volume : 59  |  Issue : 12  |  Page : 831--832

Aluminium phosphide poisoning: Need for revised treatment guidelines


Subramanian Senthilkumaran1, Chidambaram Ananth2, Ritesh G Menezes3, Ponniah Thirumalaikolundusubramanian4,  
1 Department of Emergency and Critical Care Medicine, Erode Emergency Care Hospital, Erode, Tamil Nadu, India
2 Department of Anesthesiology, Chennai Medical College and Research Centre, Irungalur, Tiruchirappalli, Tamil Nadu, India
3 Division of Forensic Medicine, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Saudi Arabia
4 Department of Internal Medicine, Chennai Medical College and Research Centre, Irungalur, Tiruchirappalli, Tamil Nadu, India

Correspondence Address:
Subramanian Senthilkumaran
Department of Emergency and Critical Care Medicine, Erode Emergency Care Hospital, Erode, Tamil Nadu
India




How to cite this article:
Senthilkumaran S, Ananth C, Menezes RG, Thirumalaikolundusubramanian P. Aluminium phosphide poisoning: Need for revised treatment guidelines.Indian J Anaesth 2015;59:831-832


How to cite this URL:
Senthilkumaran S, Ananth C, Menezes RG, Thirumalaikolundusubramanian P. Aluminium phosphide poisoning: Need for revised treatment guidelines. Indian J Anaesth [serial online] 2015 [cited 2019 Sep 21 ];59:831-832
Available from: http://www.ijaweb.org/text.asp?2015/59/12/831/171624


Full Text

Sir,

Exothermic reactions, fumes, flames and thermal injuries observed in aluminium phosphide (ALP) poisoning have been brought out by Mirakbari. [1] All know well that ALP when comes in contact with water, air or hydrochloric acid (HCL) (as in stomach), toxic phosphine gas is liberated. Potassium permanganate (KMnO 4) solution (1 in 10,000) used as gastric lavage in ALP poisoning, oxidizes phosphine to non-toxic phosphate. Here, we would like to mention the limitations of KMnO4, usefulness of vegetable oil and gastric ventilation, certain matters related to education and research and patient safety aspects of ALP poisoning.

Nasrabadi and Marashi [2] have observed that phosphine a hard nucleophile and the free oxygen radicals released from the resolution of KMnO 4 do not interact with each other. Hence, there is no well-established basis for the use of KMnO 4 solution in ALP poisoning. Moreover, an exothermic reaction while using it was noticed in the case described. [1] In view of these facts, one has to find alternatives instead of KMnO 4.

Vegetable oil administered orally or through a nasogastric tube in those cases of ALP poisoning inhibits phosphine release due to physiochemical properties of ALP and non-miscibility with fat. [3],[4] For example, coconut oil used in ALP poisoning inhibits the breakdown of phosphide, reduces the toxicity of phosphides, protects gastric mucosa, prevents the absorption of phosphine gas and dilutes gastric acid to some extent. Bajwa et al. [4] used coconut oil with sodium bicarbonate for gastric lavage, where sodium bicarbonate neutralizes HCL. As a result, it reduces the catalytic reaction of phosphide with HCL and inhibits the release of phosphine. Medicated liquid paraffin available in the emergency department can also be used to inhibit the phosphine release. Interestingly, Hassanian-Moghaddam and Shahbazi [5] had shown the usefulness of gastric ventilation in ALP poisoning.

Medical students and practitioners have to be sensitised on the changing trends in the treatment modalities of ALP poisoning. Having seen the limitations of KMnO 4 and usefulness of vegetable oil, it is the time to undertake research on early diagnosis, treatment modalities and prevention of ALP poisoning. It is also suggested to conduct a clinical audit of ALP poisoning cases and update the treatment modalities so as ensure patient safety. It is worth to recall John Eisenberg's statement 'globalize the evidence, localize the decision'.

References

1Mirakbari SM. Hot charcoal vomitus in aluminum phosphide poisoning - A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature. Indian J Anaesth 2015;59:433-6.
2Nasri Nasrabadi Z, Marashi SM. Comments on "A systematic review of aluminium phosphide poisoning". Arh Hig Rada Toksikol 2012;63:551.
3Shadnia S, Rahimi M, Pajoumand A, Rasouli MH, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: Possible benefit of coconut oil. Hum Exp Toxicol 2005;24:215-8.
4Bajwa SJ, Bajwa SK, Kaur J, Singh K, Panda A. Management of celphos poisoning with a novel intervention: A ray of hope in the darkest of clouds. Anesth Essays Res 2010;4:20-4.
5Hassanian-Moghaddam H, Shahbazi A. Gastric ventilation: A new approach to metal phosphide fumigant ingestion. Clin Toxicol (Phila) 2012;50:435-7.