Aluminum phosphide poisoning is a common lethal poisoning that has caused many deaths in India in recent decades. Aluminum phosphide is marketed as pesticide pellets or tablets used to preserve food grains. When it reacts with water, it produces phosphine gas which is toxic as it inhibits cellular respiration. Symptoms include vomiting, hypotension, and organ damage. Diagnosis involves detecting phosphine in breath or vomit. Treatment focuses on managing shock through fluids and vasopressors, as there is no antidote. Prevention requires better regulation of aluminum phosphide distribution to limit accidental or intentional ingestion.
Toxicology on aluminium phosphide, the characteristics, fatal dose,fatal period, sign and symptoms, postmortem appearance and medicolegal importance are discussed.
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Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
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Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
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The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
2. Aluminium Phosphide
• Aluminium phosphide poisoning is the
commonest lethal poisoning encountered
in clinical practice and has taken a huge
toll of human lives during the last two
decades or so.
3. Availability
• Aluminium phosphide is marketed in India
as 0.5gm pellets,3gm tablets and in powder
form under several brand names I.e
CELPHOS,
QUICKPHOS
as food grain preservative or fumigant.
4. Toxicity
• AIP + 3 H2O = AI( OH )3 + PH3
• Phosphine gas is rapidly absorbed from the stomach
and inhibits the mitochondrial respiratory chain and
hence leads to cell necrosis and death
• Phosphine resembles Cyanide in that it inhibits
cytochrome oxidase and thereby hampers cellular
oxygen utilization
Indian Journal of Pharmacology 1992 SK Tripathi et
al
5. • Phosphine gas is actually colourless and odourless
However
• Due to presence of substituted diphosphines on
exposure to air it gives garlicky or decaying fishy odour
• Lethal Dose – 0.5 gm for a 70 kg person
6. Clinical Presentation
• Initial symptoms like
-retrosternal burning
-epigastric pain
-vomiting
-hypotension(cardinal feature)
-restlessness,tachypnoea,oliguria or
anuria,jaundice,impaired sensorium,cardiac
arrthymias(due to myocardial necrosis)
9. Pathophysiology
• Various studies have shown that
• Phosphine will inhibit mitochondrial oxygen uptake
and ion stimulated respiration
• which also has direct effect on the electron
transport system which is an important
electrochemical link between respiration and
phosphorylation in mitochondria.
10. Diagnosis :
• Clinical History
• Detection of phosphine in exhaled air or gastric aspirate
by using silver nitrate impregnated strips.
• For spot sampling of phosphine, commercial air
detector tubes and bulbs are available
• Most specific and sensitive test is gas
chromatography(can detect minute amount of
phosphene in air, used for research purposes mainly )
• Cytochrome-c oxidase activity in platelets is another
marker.
11. Management :
• The management continues to be unsatisfactory as
there is no specific antidote and remains supportive
only.
• Number of vomits after ingestion and severity of
shock-correlates best with outcome.
12. Management :
• There is no RCTS to show gastric lavage will benefit
these patients.
• Potassium permanganate (1:10000)has been tried for
removing the unabsorbed phosphine as well as to
oxidize it.
• Activated charcoal 50-100gm activated charcoal is
given orally to adsorb phosphene.
• Medicated liquid paraffin
13. Management …
• The main factor is treatment of shock and
hypotension with appropriate measures
• SHOCK / HYPOTENSION – Fluids ,
Vasopressors
• Phosphine is excreted by lungs and kidney. To
enhance its excretion adequate BP and renal
perfusion needs to be maintained.
14. • Magnesium sulphate
-Membrane stabilizer which can reverse
arrhythmias.
-Antiperoxidant activity
-It has been claimed to reduce mortality
• Corticosteriods-in compromised adrenal function
Management ….
