CRITICAL REVIEW ON SUPPORTIVE TREATMENT MEASURES IN ACUTE ALUMINUM PHOSPHIDE TOXICITY
Main Article Content
Keywords
Aluminum phosphide poisoning, Phosphine gas, Supportive care, Oxidative stress, Multi-organ failure, Mitochondrial dysfunction
Abstract
Acute aluminum phosphide (AlP) poisoning represents one of the most challenging toxicological emergencies globally due to its high fatality rates and lack of a specific antidote. Phosphine gas, released upon AlP’s exposure to moisture or gastric acid, disrupts mitochondrial oxidative phosphorylation, generating reactive oxygen species and precipitating systemic multi-organ failure. The primary management approach is supportive care, encompassing aggressive hemodynamic stabilization, respiratory support, and correction of severe metabolic acidosis. However, the rapid progression of toxicity, coupled with resource limitations in many affected regions, often leads to poor outcomes. Emerging interventions, including antioxidant therapies, mitochondrial protective agents, and advanced extracorporeal techniques such as extracorporeal membrane oxygenation (ECMO), show potential for improving survival. Concurrently, research into biomarkers for early severity prediction and the development of phosphine-neutralizing agents offers hope for more targeted approaches. Addressing the high mortality associated with AlP poisoning requires a multidisciplinary strategy, combining advancements in clinical care, stricter regulation of AlP distribution, and public health initiatives to mitigate its misuse, particularly for self-harm. Future innovations and equitable access to advanced medical interventions are essential to reducing the global burden of this highly lethal poisoning.
References
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3. Zeng, Q., Yi, H., Huang, L., An, Q., & Wang, H. (2018). Reduced testosterone and Ddx3y expression caused by long-term exposure to arsenic and its effect on spermatogenesis in mice. Environmental toxicology and pharmacology, 63, 84-91.
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5. Rathod, A. L., & Garg, R. K. (2017). Chlorpyrifos poisoning and its implications in human fatal cases: A forensic perspective with reference to Indian scenario. Journal of forensic and legal medicine, 47, 29-34.
6. Zeng, Q., Yi, H., Huang, L., An, Q., & Wang, H. (2018). Reduced testosterone and Ddx3y expression caused by long-term exposure to arsenic and its effect on spermatogenesis in mice. Environmental toxicology and pharmacology, 63, 84-91.
7. Æbelø, A. M., Noer, V. R., Schulz, M. K., Kristensen, B. W., Pedersen, C. B., & Poulsen, F. R. (2019). Frameless stereotactic neuronavigated biopsy: a retrospective study of morbidity, diagnostic yield, and the potential of fluorescence: a single-center clinical investigation. Clinical neurology and neurosurgery, 181, 28-32.
8. Aimo, A., Januzzi Jr, J. L., Mueller, C., Mirò, O., Figal, D. A. P., Jacob, J., ... & Emdin, M. (2019). Admission high-sensitivity troponin T and NT-proBNP for outcome prediction in acute heart failure. International journal of cardiology, 293, 137-142.
9. Gurjar, M., Baronia, A. K., Azim, A., & Sharma, K. (2011). Managing aluminum phosphide poisonings. Journal of emergencies, trauma, and shock, 4(3), 378-384.
10. Gupta, S., & Ahlawat, S. K. (1995). Aluminum phosphide poisoning—a review. Journal of Toxicology: Clinical Toxicology, 33(1), 19-24.
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15. Moghadamnia, A. A. (2012). An update on toxicology of aluminum phosphide. DARU journal of Pharmaceutical Sciences, 20, 1-8.
16. Agrawal, V. K., Bansal, A., Singh, R. K., Kumawat, B. L., & Mahajan, P. (2015). Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(2), 109.
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21. Babu, R., Raghavi, B., Manpreet, K., & Rohtagi, S. (2021). A rare case of aluminum phosphide poisoning survival: Role of early and aggressive supportive therapy. J Indian Acad Clin Med, 22(1-2), 63-68.
22. Yadav, D., Bhattacharyya, R., & Banerjee, D. (2021). Acute aluminum phosphide poisoning: The menace of phosphine exposure. Clinica Chimica Acta, 520, 34-42.
23. Sobh, Z. K., Ghanem, M., & Kholief, M. (2023). Physicians’ perspectives on different therapeutic approaches for aluminum phosphide poisoning and their relevant outcomes. Toxicology Research, 12(4), 615-625.