Journal of Kerman University of Medical Sciences

Current Issue

By Issue

By Author

Author Index

Keyword Index

About Journal

Aims and Scope

JKMU Ethical Policies

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

News

Metric

Editorial Policies

Data Sharing Policy

Aluminum Phosphide Poisoning, Mechanism of Action and Treatment: a Literature Review

Document Type : Review Article

Authors

1 Ph.D. Candidate Medical Toxicology Research Centere, Faculty of Medicine Mashhad University of Medical Sciences, Mashhad, Iran

2 Ph.D. Candidate Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate Professor, Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Assistant Professor, Emergency Medicine Department, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Aluminum phosphide (AlP) is an important fumigant, a commendable and very effective outdoor and indoor insecticide. AlP, locally named “rice tablet”, is widely used to protect rice. As soon as taking a very small amount of an AlP tablet, phosphine vaporizes due to the exposure to the air and affects different kinds of organs. Although, in most cases, clinical history can help making the final diagnosis, analytical tests such as gas chromatographic method in post-mortem specimens and survivors have been developed to measure the level of phosphine and to distinguish between ZnP and AlP poisoning.
AlP poisoning management should be started quickly. In addition to supportive therapy, various antioxidant agents, as candidate protective factors, such as N-acetylcysteine (NAC), melatonin, glutathione, magnesium, β-carotene, and vitamin C and E have also been recommended to decrease oxidative damage and cardiotoxicity due to the limited antioxidant defense systems.
The present study highlights the fact that Antioxidant therapy in severe ALP poisoning confers different survival benefits. This literature review showed that the administration of antioxidant therapy in addition to the supportive treatment may decrease the mortality rate and could be considered in the treatment of acute AlP poisoning in combination with other therapeutic protocols.

Keywords

References
  1. Chopra J, Kalra O, Malik V, Sharma R, Chandna A. Aluminium phosphide poisoning: a prospective study of 16 cases in one year. Postgraduate medical journal. 1986;62(734):1113-5.
  2. Singh D, Dewan I, Pandey AN, Tyagi S. Spectrum of unnatural fatalities in the Chandigarh zone of north-west India–a 25 year autopsy study from a tertiary care hospital. Journal of clinical forensic medicine. 2003;10(3):145-52.
  3. Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. Journal of Emergencies, Trauma and Shock. 2011;4(3):378.
  4. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clinical toxicology. 2009;47(2):89-100.
  5. Moffat AC, Osselton MD, Widdop B, Clarke E. Clarke's analysis of drugs and poisons: in pharmaceuticals, body fluids and postmortem material s. Vol. 1: Pharmaceutical Press; 2004.
  6. Wexler P. Encyclopedia of toxicology: Elsevier; 2005.
  7. Saleki S, Ardalan FA, Javidan-Nejad A. Liver histopathology of fatal phosphine poisoning. Forensic science international. 2007;166(2-3):190-3.
  8. Anger F, Paysant F, Brousse F, Normand IL, Develay P, Galliard Y, et al. Fatal aluminum phosphide poisoning. Journal of analytical toxicology. 2000;24(2):90-2.
  9. Bayazıt AK, Noyan A, Anarat A. A child with hepatic and renal failure caused by aluminum phosphide. Nephron. 2000;86(4):517-.
  10. Popp W, Mentfewitz J, Götz R, Voshaar T. Phosphine poisoning in a German office. The Lancet. 2002;359(9317):1574.
  11. Mehrpour O, Singh S. Rice tablet poisoning: a major concern in Iranian population. Human and experimental toxicology. 2010;29(8):701.
  12. Murali R, Bhalla A, Singh D, Singh S. Acute pesticide poisoning: 15 years experience of a large North-West Indian hospital. Clinical toxicology. 2009;47(1):35-8.
  13. Mittra S, Peshin S, Lall S. Cholinesterase inhibition by aluminium phosphide poisoning in rats and effects of atropine and pralidoxime chloride. Acta Pharmacologica Sinica. 2001;22(1):37-9.
  14. Moghadamnia AA. An update on toxicology of aluminum phosphide. DARU journal of Pharmaceutical Sciences. 2012;20(1):25.
  15. Ranga G, Dwivedi S, Agarwal M, Kumar D. Aluminium phosphide poisoning in a young adult: a suicidal cardiotoxin simulating myocardial ischaemia. J Indian Acad Clin Med. 2004;5(4):369.
  16. Singh S, Bhalla A, Verma SK, Kaur A, Gill K. Cytochrome-c oxidase inhibition in 26 aluminum phosphide poisoned patients. Clinical Toxicology. 2006;44(2):155-8.
  17. Goel A, Aggarwal P. Pesticide poisoning. National medical journal of India. 2007;20(4):182.
  18. Tiwary AK, Puschner B, Charlton BR, Filigenzi MS. Diagnosis of zinc phosphide poisoning in chickens using a new analytical approach. Avian diseases. 2005;49(2):288-91.
  19. Azoury M, Levin N. Identification of zinc phosphide in a falsely labeled rodenticide bait. Journal of Forensic Science. 1998;43(3):693-5.
  20. Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology. 2012;63(1):61-73.
  21. Moghadamnia A, Khalilian E, Mahdipour E, Salar N, Ghafouri M. Epidemiological study of poisoning in Babol. J Babol Univ Med Sci. 2012:1-8.
  22. Shadnia S, Soltaninejad K, Hassan ian-Moghadam H, Sadeghi A, Rahimzadeh H, Zamani N, et al. Methemoglobinemia in aluminum phosphide poisoning. Human & experimental toxicology. 2011;30(3):250-3.
  23. Kapoor A, Sinha U, Singh A, Mehrotra R. An epidemiological study of aluminium phosphide poisoning at Allahabad. Indian Internet Journal of Forensic Medicine & Toxicology. 2006;4(1).
  24. 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. Clinical toxicology. 2005;43(6):575-81.
  25. Bogle R, Theron P, Brooks P, Dargan P, Redhead J. Aluminium phosphide poisoning. Emergency Medicine Journal. 2006;23(1):e03-e.
  26. Sinha N. Aluminium phosphide poisoning. Indian Journal of Medical Specialities. 2018.
  27. Bumbrah GS, Krishan K, Kanchan T, Sharma M, Sodhi GS. Phosphide poisoning: a review of literature. Forensic Sci Int. 2012;214(1-3):1-6.
  28. Dadpour B, Mokhtarpour M, Abdollahi M, Afshari R. An outbreak of aluminium phosphide poisoning in Mashhad, Iran. Arhiv za higijenu rada i toksikologiju. 2016;67(1):65-6.
  29. Dua R, Gill KD. Aluminium phosphide exposure: implications on rat brain lipid peroxidation and antioxidant defence system. Basic & Clinical Pharmacology & Toxicology. 2001;89(6):315-9.
  30. Chugh S, Arora V, Sharma A, Chugh K. Free radical scavengers & lipid peroxidation in acute aluminium phosphide poisoning. The Indian journal of medical research. 1996;104:190-3.
  31. Aggarwal P, Handa R, Wig N, Biswas A, Saxena R, Wali JP. Intravascular hemolysis in aluminium phosphide poisoning. The American journal of emergency medicine. 1999;17(5):488-9.
  32. Jain AK, Nigam M, Garg S, Dubey B, Arora A. Aluminium phosphide poisoning autopsy findings. 2005.
  33. Farahani MV, Soroosh D, Marashi SM. Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An evidence-based review. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2016;20(12):724.
  34. Ntelios D, Mandros C, Potolidis E, Fanourgiakis P. Aluminium phosphide-induced leukopenia. BMJ case reports. 2013;2013.
  35. Anand R, Binukumar B, Gill KD. Aluminum phosphide poisoning: an unsolved riddle. Journal of applied toxicology. 2011;31(6):499-505.
  36. Abder-Rahman HA. Aluminum phosphide fatalities at mild exertion in asymptomatic children: a clue to understand the variations of the autopsy findings. Journal of forensic and legal medicine. 2009;16(6):312-5.
  37. Jain S, Bharani A, Sepaha G, Sanghvi V, Raman P. Electrocardiographic changes in aluminium phosphide (ALP) poisoning. The Journal of the Association of Physicians of India. 1985;33(6):406-9.
  38. Bagheri-Moghaddam A, Abbaspour H, Tajoddini S, Mohammadzadeh V, Moinipour A, Dadpour B. Using Intra-Aortic Balloon Pump for Management of Cardiogenic Shock Following Aluminum Phosphide Poisoning; Report of 3 Cases. Emergency (Tehran, Iran). 2018;6(1):e3.
  39. Singh S, Bhalla A. Aluminum phosphide poisoning. Journal of Mahatma Gandhi Institute of Medical Sciences. 2015;20(1):15.
  40. Soltaninejad K, Beyranvand MR, Momenzadeh SA, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. Journal of forensic and legal medicine. 2012;19(5):291-3.
  41. Jain RK, Gouda NB, Sharma VK, Dubey TN, Shende A, Malik R, et al. Esophageal complications following aluminium phosphide ingestion: an emerging issue among survivors of poisoning. Dysphagia. 2010;25(4):271-6.
  42. Shadnia S, Soltaninejad K. Spontaneous ignition due to intentional acute aluminum phosphide poisoning. Journal of Emergency Medicine. 2011;40(2):179-81.
  43. Burgess JL, Burgess J. Phosphine exposure from a methamphetamine laboratory investigation. Journal of Toxicology: Clinical Toxicology. 2001;39(2):165-8.
  44. Mathur A, Swaroop A, Aggarwal A. ECG changes in aluminium phosphide and organo phosphorus poisoning. Indian Pract. 1999;52:249-52.
  45. Chugh S, Ram S, Chugh K, Malhotra K. Spot diagnosis of aluminium phosphide ingestion: an application of a simple test. The Journal of the Association of Physicians of India. 1989;37(3):219-20.
  46. Carlson M, Thompson RD. Determination of phosphine residues in whole grains and soybeans by ion chromatography via conversion to phosphate. Journal of AOAC International. 1998;81(6):1190-201.
  47. Hugar BS, Praveen S, Hosahally JS, Kainoor S, Shetty ARS. Gastrointestinal hemorrhage in aluminum phosphide poisoning. Journal of forensic sciences. 2015;60:S261-S3.
  48. Anand R, Kumari P, Kaushal A, Bal A, Wani WY, Sunkaria A, et al. Effect of acute aluminum phosphide exposure on rats—A biochemical and histological correlation. Toxicology letters. 2012;215(1):62-9.
  49. Chugh S, Ram S, Sharma A, Arora B, Saini A, Malhotra K. Adrenocortical involvement in aluminium phosphide poisoning. The Indian journal of medical research. 1989;90:289-94.
  50. Jadhav AP, Nusair MB, Ingole A, Alpert MA. Unresponsive ventricular tachycardia associated with aluminum phosphide poisoning. Am J Emerg Med. 2012;30(4):633.e3-5.
  51. Akkaoui M, Achour S, Abidi K, Himdi B, Madani A, Zeggwagh AA, et al. Reversible myocardial injury associated with aluminum phosphide poisoning. Clinical toxicology. 2007;45(6):728-31.
  52. 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. Clinical Toxicology. 2013;51(1):23-8.
  53. Jafari A, Baghaei A, Solgi R, Baeeri M, Chamanara M, Hassani S, et al. An electrocardiographic, molecular and biochemical approach to explore the cardioprotective effect of vasopressin and milrinone against phosphide toxicity in rats. Food and Chemical Toxicology. 2015;80:182-92.
  54. Lakshmi B. Methaemoglobin formation with aluminium phosphide poisoning. Am J Emerg Med. 2002;20:1-3.
  55. 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(7):761-4.
  56. 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(5):518-22.
  57. Pajoumand A, Jalali N, Abdollah M, Shadnia S. Survival following severe aluminium phosphide poisoning. Journal of Pharmacy Practice and Research. 2002;32(4):297-9.
  58. Oghabian Z, Mehrpour O. Treatment of aluminium phosphide poisoning with a combination of intravenous glucagon, digoxin and antioxidant agents. Sultan Qaboos University Medical Journal. 2016;16(3):e352.
  59. Baeeri M, Shariatpanahi M, Baghaei A, Ghasemi-Niri SF, Mohammadi H, Mohammadirad A, et al. On the benefit of magnetic magnesium nanocarrier in cardiovascular toxicity of aluminum phosphide. Toxicology and industrial health. 2013;29(2):126-35.
  60. Siwach S, Katyal V, Dhall A, Bhardwaj G. Prognostic indices in aluminium phosphide poisoning: Observations on acidosis and central venous pressure. Journal of Association of Physicians of India. 1997;45(9):693-6.
  61. Duenas A, Pérez-Castrillon J, Cobos M, Herreros V. Treatment of the cardiovascular manifestations of phosphine poisoning with trimetazidine, a new antiischemic drug. The American journal of emergency medicine. 1999;17(2):219-20.
  62. Mehrpour O, Amouzeshi A, Dadpour B, Oghabian Z, Zamani N, Amini S, et al. Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology. 2014;65(1):121-7.
  63. Sanaei-Zadeh H, Farajidana H. Is there a role for digoxin in the management of acute aluminum phosphide poisoning? Medical hypotheses. 2011;76(5):765-6.
  64. Dadpour B, Oghabian Z. Acute Anterolateral Myocardial Infarction Due to Aluminum Phosphide Poisoning. Journal of Cardio-Thoracic Medicine. 2013;1(2):67-70.
  65. Gupta M, Malik A, Sharma V. Cardiovascular manifestations in aluminium phosphide poisoning with special reference to echocardiographic changes. The Journal of the Association of Physicians of India. 1995;43(11):773-4, 9-80.
  66. Perez Navero JL, Ibarra de la Rosa I, Frias Perez MA, Arroyo Marin MJ, Perez Jorge P. Fatal poisoning by accidental inhalation of aluminium phosphide. Anales de pediatria (Barcelona, Spain : 2003). 2009;71(5):427-31.
  67. Chugh S, Ram S, Mehta L, Arora B, Malhotra K. Adult respiratory distress syndrome following aluminium phosphide ingestion. Report of 4 cases. The Journal of the Association of Physicians of India. 1989;37(4):271-2.
  68. Yang Y, Sun Y, Yi W, Li Y, Fan C, Xin Z, et al. A review of melatonin as a suitable antioxidant against myocardial ischemia–reperfusion injury and clinical heart diseases. Journal of pineal research. 2014;57(4):357-66.
  69. Mukherjee D, Ghosh AK, Dutta M, Mitra E, Mallick S, Saha B, et al. Mechanisms of isoproterenol‐induced cardiac mitochondrial damage: protective actions of melatonin. Journal of pineal research. 2015;58(3):275-90.
  70. Korkmaz A, Reiter RJ, Topal T, Manchester LC, Oter S, Tan D-X. Melatonin: an established antioxidant worthy of use in clinical trials. Molecular Medicine. 2009;15(1-2):43.
  71. Marin-Garcia J, Goldenthal MJ, Moe GW. Mitochondrial pathology in cardiac failure. Cardiovascular research. 2001;49(1):17-26.
  72. Iyanda A. Assessment of lipid peroxidation and activities of antioxidant enzymes in phosphide-powder residue exposed rats. J Drug Metab Toxicol. 2012;3:132.
  73. Escames G, López A, Antonio Garcia J, García L, Acuña-Castroviejo D, Joaquin Garcia J, et al. The role of mitochondria in brain aging and the effects of melatonin. Current neuropharmacology. 2010;8(3):182-93.
  74. Asghari MH, Moloudizargari M, Baeeri M, Baghaei A, Rahimifard M, Solgi R, et al. On the mechanisms of melatonin in protection of aluminum phosphide cardiotoxicity. Archives of toxicology. 2017;91(9):3109-20.
  75. Bertuglia S, Reiter RJ. Melatonin reduces ventricular arrhythmias and preserves capillary perfusion during ischemia‐reperfusion events in cardiomyopathic hamsters. Journal of pineal research. 2007;42(1):55-63.
  76. Azad A, Lall S, Mittra S. Effect of N-acetylcysteine and L-NAME on aluminium phosphide induced cardiovascular toxicity in rats. Acta pharmacologica Sinica. 2001;22(4):298-304.
  77. Bhalla A, Jyothinath P, Singh S. Antioxidant Therapy in Patients with Severe Aluminum Phosphide Poisoning: A Pilot Study. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2017;21(12):836-40.

Journal of Kerman University of Medical Sciences
Volume 26, Issue 5
September and October 2019
Pages 406-419
Files
Share
How to cite
Statistics