potassium-permanganate and aluminum-phosphide

Topics: Aluminum Compounds; Burns, Chemical; Humans; Phosphines; Poisoning; Potassium Permanganate

Topics: Administration, Oral; Aluminum Compounds; Antidotes; Charcoal; Drug Administration Schedule; Health Knowledge, Attitudes, Practice; Humans; Molecular Weight; Phosphines; Poisoning; Potassium Permanganate; Treatment Outcome

Phosphine is absorbed rapidly across mucous membranes causing systemic poisoning including functional cellular hypoxia. Following ingestion of metal phosphides, continuous absorption of phosphine could contribute to the intractable systemic manifestations.. A 16-year-old male was admitted to hospital 1-hour post-ingestion of two fresh 3 g tablets of aluminum phosphide 56%. He complained of abdominal discomfort and burning pain, thirst, nausea, and foul-odor vomitus. The silver nitrate test was positive by exhaled breath and gastric content, confirming exposure to phosphine. Initial therapy included intravenous fluids and gastric lavage with sodium bicarbonate and potassium permanganate. Hypotension, severe agitation and tachypnea prompted endotracheal intubation and treatment with gastric ventilation. This procedure involves insertion of a nasogastric tube to insufflate air into the distal part of the stomach. An orogastric tube is inserted near the gastro-esophageal junction as an inflow air tract. Ventilation was provided by blowing fresh air using an air-pump into the naso-gastric tube and phosphine contaminated air escaped via the wide-bore orogastric tube; the treatment continued for several hours. Although there was some evidence of progression of poisoning, including metabolic acidosis, arterial fibrillation, and mild gastrointestinal bleeding, the patient subsequently recovered and was discharged 6 days later with no persisting complications. This case report discusses probable benefit, availability, and simplicity of this treatment. We suggest that further clinical trials are required to confirm that this treatment improves outcomes in this highly toxic poisoning.

Topics: Adolescent; Aluminum Compounds; Breath Tests; Gastric Lavage; Humans; Insufflation; Intubation, Gastrointestinal; Male; Pesticides; Phosphines; Potassium Permanganate; Silver Nitrate; Sodium Bicarbonate; Stomach; Suicide, Attempted; Treatment Outcome

Aluminum phosphide (AlP) is used as a fumigant. It produces phosphine gas, which is a mitochondrial poison. Unfortunately, there is no known antidote for AlP intoxication, and also, there are few data about its prognostic factors.. The aim of this study was to determine the impact of the Simplified Acute Physiology Score II (SAPS II ) in the prediction of outcome in patients with acute AlP poisoning requiring admission to the Intensive Care Unit (ICU).. This was a prospective study in patients with acute AlP poisoning, admitted to the ICU over a period of 12 months. The demographic data were collected and SAPSII was recorded. The patients were divided into survival and non-survival groups due to outcome.. The data were expressed as mean ± SD for continuous or discrete variables and as frequency and percentage for categorical variables. The results were compared between the two groups using SPSS software. Results : During the study period, 39 subjects were admitted to the ICU with acute AlP poisoning. All 39 patients required endotracheal intubation and mechanical ventilation in addition to gastric decontamination with sodium bicarbonate, permanganate potassium, and activated charcoal, therapy with MgSO 4 and calcium gluconate and adequate hydration. Among these patients, 26 (66.7%) died. SAPSII was significantly higher in the non-survival group than in the survival group (11.88 ± 4.22 vs. 4.31 ± 2.06, respectively) (P < 0.001).. SAPSII calculated within the first 24 hours was recognized as a good prognostic indicator among patients with acute AlP poisoning requiring ICU admission.

Topics: Adolescent; Adult; Aluminum Compounds; Antidotes; Charcoal; Female; Forecasting; Humans; Male; Middle Aged; Pesticides; Phosphines; Poisoning; Potassium Permanganate; Prospective Studies; Severity of Illness Index; Sodium Bicarbonate; Treatment Outcome; Young Adult