Successful management of aluminum phosphide (ALP) poisoning in a teaching hospital in Shahroud: A case report
Authors
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Tahereh NaseriBooriAbadi
Department of Health Education and Promotion, School of Health, Arak University of Medical Sciences, Arak, Iran. 2 Department of Health Information Technology, School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran.
https://orcid.org/0000-0001-7300-924X
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Seyed Meysam Yekesadat
Department of Clinical Sciences, School of Medicine, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
https://orcid.org/0000-0002-1447-371X
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Farideh Sadeghian
Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
https://orcid.org/0000-0001-7173-6451
DOI:
https://doi.org/10.22100/ijhs.v11i1.1264Keywords:
poisoning, suicide attempt, aluminum phosphide, case report, teaching hospitalAbstract
In Iran, herbal or chemical rice tablets containing ALP protect grains from pests. Deaths have been reported following both accidental and intentional exposure to aluminum phosphide. A 20-year-old woman who intentionally ingested a 3-gram ALP tablet and became poisoned is the primary focus of this case report. It outlines the successful management of a patient who had taken a rice tablet and suffered from acute cardiogenic shock, severe metabolic acidosis, and severe hypotension.
This patient survived successfully despite the higher mortality rate due to cardiac and multi-organ problems from exposure to phosphine gas, particularly the rice tablet and cellular hypoxia. In addition to daily supportive therapies, an antioxidant regimen, glucose, insulin, and potassium (GIK), and prompt intubation to improve cardiac function assisted with the recovery.
References
Mehrpour O, Aghabiklooei A, Abdollahi M, Singh S. Severe Hypoglycemia Following Acute Aluminum Phosphide (Rice Tablet) Poisoning; A Case Report and Review of the Literature. Acta Medica Iranica. 2012; 50(8): 568-71. https://acta.tums.ac.ir/index.php/acta/article/view/3951/3926
Sarkar MK, Ghosh N, Rakesh U, Prasad R, Raj R. Acute aluminium phosphide poisoning: A case report of rare survival with cardiac, metabolic, hepatic, and renal complications. Journal of family medicine and primary care. 2022;11(11):7452-5. doi:10.4103/jfmpc.jfmpc_615_22
Eisa G, Ebrahem NE, Abdel-Hady RH, Shaltout E. Evaluation of Suicidal Poisoning Cases Admitted to Emergency Units of Assuit University Hospitals, Egypt. Zagazig Journal of Forensic Medicine and Toxicology. 2024;22(1):127-46. doi:10.21608/zjfm.2023.232730.1162
Shrirame V, Vr D, Gupta P. The comparative study of mortality rate on Aluminium phosphide poisoning in three districts of Himachal Pradesh. International Journal of Forensic Medicine. 2024. doi:10.33545/27074447.2024.v6.i1b.81
Zaghary MMS, Ali HAA, Ahmed AMK. The performance of ejection fraction as a predictor of mortality and morbidity in acute aluminium phosphide poisoning. Toxicology Research. 2025;14(1).
doi: 10.1093/toxres/tfae232
Edde P, Kortbawi AE, Halabi Z, Sakr N, Barakat A, Zahran TE. The first reported mortality from aluminum phosphide poisoning in Lebanon: a case report. International Journal of Emergency Medicine. 2024;17(1):18. doi:10.1186/s12245-024-00591-8
Navabi SM, Navabi J, Aghaei A, Shaahmadi Z, Heydari R. Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: characteristics and predictive factors. Epidemiology and health. 2018;40:e2018022.
doi:10.4178/epih.e2018022.
Shadnia S, Mehrpour O, Abdollahi M. Unintentional poisoning by phosphine released from aluminum phosphide. Human & experimental toxicology. 2008;27(1):87-9.
doi: 10.1177/0960327107086241
Bagherian F, Kalani N, Rahmanian F, Abiri S, Hatami N, Foroughian M, et al. Aluminum Phosphide Poisoning Mortality Rate in Iran; a Systematic Review and Meta-Analysis. Archives of academic emergency medicine. 2021;9(1):e66. doi:10.22037/aaem.v9i1.1396
Gebray HM, Chekol AL. Survival after aluminum phosphide poisoning with cardiotoxicity: a case report. Journal of Medical Case Reports. 2024;18(1):614.
https://doi.org/10.1186/s13256-024-04988-0
A. Nosrati, M. Karami, M. Esmaeilnia, Aluminum Phosphide Poisoning: A Case Series in North Iran, Asia Pacific Journal of Medical Toxicology 2(3) (2013) 111-113, https://doi.org/10.22038/apjmt.2013.1674
Askkarpour H, Amiri M, Naderi Lordjani M, Amiri V, KHodamoradi A, khalilzadeh M. A Case Report of Successful Treatment of Aluminum Phosphide Poisoning. Journal of Health. 2020;11(3):432-7.
https://healthjournal.arums.ac.ir/files/site1/user_files_902ca9/mohamadkian-A-10-608-153-bb3fa2f.pdf
Katwal S, Malbul K, Mandal SK, Kc S, Alam MZ, Karki P, et al. Successfully managed aluminum phosphide poisoning: A case report. Annals of Medicine and Surgery. 2021;70:102868. https://doi.org/10.1016/j.amsu.2021.102868
Fayyaz F. Changes in Some Hematology Parameters in poisoning with Rice Tablet (Aluminum Phosphide). Medical Laboratory Journal. 2015;9(4):43-6.
https://mlj.goums.ac.ir/article-1-778-en.pdf
Sobh ZK, Kholief M, Sobh EK, Balah MIF. Exploring research gaps and trends in the management of acute phosphide poisoning: a systematic review. Critical reviews in toxicology. 2023;53(3):181-206. 10.1080/10408444.2023.2225539.
Hassanian-Moghaddam H, Zamani N. Therapeutic role of hyperinsulinemia/euglycemia in aluminum phosphide poisoning. Medicine. 2016;95(31):e4349.
1097/MD.0000000000004349
Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. Journal of emergencies, trauma, and shock. 2011;4(3):378-84. 10.4103/0974-2700.83868
Karimi R, Taheri H. Report on Two Successful Treatment of Rice Pill Poisoning, Journal of Babol University of Medical Sciences. 2007; 9(1): 58-62. https://jbums.org/article-1-3048-fa.html
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. 10.3109/15563650.2012.743029.
Kamaloddini MH, Zohoorian P, Foroughian M, Hemmati Awli S, Teimouri A. Successful Treatment of Acute Aluminum Phosphide Poisoning: Possible Benefit of Olive Oil - A Case Report. Updates in Emergency Medicine. 2022;1(1):47-51. https://doi.org/10.52547/uiemj.1.1.47
Shakeri M, Shakeri H, Rahmanian Z, Mogharab F, Kalani N, Rostami Pourfard HA. A case report of successful treatment following rice pill poisoning in a 60-year-old woman. Pars Journal of Medical Sciences. 2022;19(3):9-13. doi: 10.22034/pjms.2022.700478
Azad A, Lall SB, 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. http://www.chinaphar.com/article/view/7394/8136
Hussien S, Al Teftazany E, Hagras A, Elhelaly H, Abdelhamed W. N-acetylcysteine Use in Treatment of Acute Aluminium Phosphide Poisoning: Systematic Review and Meta-Analysis. Ain Shams Journal of Forensic Medicine and Clinical Toxicology. 2023;41(2):50-62. https://ajfm.journals.ekb.eg/article_310229_370bb9755cb80fb85da502e3abc6c106.pdf
The Secretariat of the Strategic Council for the Development of Health Guidelines, Diagnostic and theraputic protocol for the poisoning with ALP, in: MOHME. Deputy of Treatment (Ed.) Deputy of Treatment, Ministry of Health and Medical Education 2020.
Bogale DE, Ejigu BD, Muche TA. Clinical Profile and Treatment Outcome of Aluminum Phosphide Poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: A Retrospective Study. Open Access Emergency Medicine. 2021;13(null):239-48. Doi: 10.2147/OAEM.S313181
Mohammadpour AH, Samadi S, Sadjadi SA, Vafaeipour Z. Efficacy of therapeutic options in patients with aluminum phosphide poisoning. Discover Toxicology. 2024;1(1):10.
Pannu AK, Bhalla A, Gantala J, Sharma N, Kumar S, Dhibar DP. Glucose-insulin-potassium infusion for the treatment of acute aluminum phosphide poisoning: an open-label pilot study. Clinical Toxicology. 2020;58(10):1004-9. Doi:10.1080/15563650.2020.1719131
Ullah A, Jan S, Shahzad H, Dar M.R, Khan S, Ahmad K, Abdullah A, Khan M.R, Obaid M, Khalid M. Therapeutic Effect of Glucose-Insulin-Potassium (GIK) Infusion Therapy in the Treatment of Acute Aluminum Phosphide Poisoning: An Institutional Study, Cureus. 2024;16(12): e76182.
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