Subject: aluminum phosphide
Subject: phosphine
Subject: toxicity
Subject: treatment protocols
Subject: outcome
Year: 2021
Type: Article
Title: FATAL ACUTE ALIMINIUM PHOSPHIDE POISONING - CASE REPORT AND LITERATURE REVIEW WITH REFERENCE TO CURRENT TREATMENT PROTOCOLS AND OUTCOME
Author: Petkovska, Lidija
Author: Babulovska, Aleksandra
Author: Simonovska, Natasha
Author: Kostadinovski, Kristin
Author: Brezovska Kavrakova, Julijana
Author: Zafirova Ivanovska, Beti
Abstract: Aluminum phosphide (AlP) has been known for more than 80 years as an effective pesticide for grain protection, but also as a suicidal agent used for human self-poisoning. Phosphine gas released in contact with stomach acid after oral ingestion of AlP is responsible for its toxicity. The poison affects all systems, so the mortality rate is quite high, especially after deliberate ingestions. We report the first case of severe AlP poisoning seen in our institution with a fatal outcome and fur- thermore, we present literature review on existing and newer treatment options. A 35-year-old woman with a history of epilepsy was admit - ted to the University Clinic for Toxicology in Skopje two hours after deliberate ingestion of one tablet of phostoxin (AlP). The first signs of poisoning were vomiting and abdominal pain, leu- kocytosis, prolonged PT, as well as inverted T waves in D3, AVF and left precordial leads on ECG. After developing respiratory failure and hypotension she was transferred to the intensive care unit (ICU). Her blood pressure was 80/40 mmHg, pulse rate 120/ min. Laboratory findings showed signs of hepatic lesion, rhab- domyolysis and renal failure (AST 2267.42 U/L, ALT 2102.26 U/L, CPK 1334.81U/L, blood urea nitrogen 23.03 mmol/L, creatinine 211.9 μmol/L). Arterial blood gas analyses showed metabolic acidosis (pO2 9.6 kPa, pCO2 4.14 kPa, pH 7.15, bicar- bonate 11 mmol/L, BE -15). The patient was placed on mechani- cal ventilation. Despite fluid supplementation, intensive therapy and inotropic support, hemodynamic instability worsened and cardiopulmonary resuscitation was performed three times. Unfortunately, the patient had a fatal outcome on the fourth day of intoxication. Solid formulations of AlP are very toxic. One tablet of phostoxin containing 3 grams of AlP is sufficient for the progression of life- threatening symptoms and fatal outcome. In the absence of antidote and elucidated mechanisms of toxicity, the key to treatment is rapid decontamination and initiation of resuscitation measures.
Publisher: Georgian Association of Business Press
Relation: Georgian Medical News
Identifier: oai:repository.ukim.mk:20.500.12188/15974
Identifier: 1512-0112
Identifier: http://hdl.handle.net/20.500.12188/15974
