Emerging management strategies for aluminum phosphide poisoning

Aluminum Phosphide (AlP), commonly known as Celphos in India, is a highly toxic pesticide used for grain preservation. Upon contact with moisture, it releases Phosphine gas (PH₃), leading to mitochondrial dysfunction, oxidative stress, and multi-organ failure. With no specific antidote available, AlP poisoning carries a high mortality rate, necessitating prompt life-supportive care. The aim was to evaluate the effectiveness of early gastric lavage with coconut oil and sodium bicarbonate (SBC), combined with antioxidant therapy, in improving survival outcomes in severe AlP poisoning. This retrospective study analyzed clinical cases of AlP poisoning involving the ingestion of 3 to 9 grams of AlP tablets. All patients underwent early gastric lavage within 6 hours of ingestion and received antioxidants (Vitamin E, Glutathione, N-acetylcysteine ), and supportive therapy, including vasopressors and peritoneal dialysis as needed. All patients presented with severe hypotension, metabolic acidosis, and multi-organ dysfunction. Despite presenting in critical condition, three patients survived and one patient succumbed, indicating favorable outcomes following treatment. Early gastric decontamination with coconut oil and sodium bicarbonate (SBC), supplemented by antioxidant therapy, shows promise in reducing mortality in AlP poisoning. Further studies are needed to establish standardized treatment protocols.