Aluminium phosphide poisoning

Aluminium phosphide (AlP) is a commonly used rodenticide, is easily available and very cheap. However, it is a highly toxic compound (mortality ranging from 30%-100%) and is one of the most commonly used suicidal poison. It is the liberation of phosphine from AlP which produces the toxic effects. Clinical symptoms of AlP poisoning can range from nausea, vomiting to cardiac arrhythmias, ARDS and disseminated intravascular coagulation. Diagnosis is based on history of ingestion and if in doubt, by testing gastric contents on silver nitrate impregnated paper test. Different studies have noted certain clinical and laboratory features that predict mortality in AlP poisoning. Treatment is mainly supportive with no specific antidote. Gastric lavage with coconut oil has been effective and so has intravenous treatment with 20% intra lipid emulsion. Boric acid has been proposed as an antidote but requires further validation. Being commonly used by agricultural workers for their crop protection, proper handling of AlP needs to be done to prevent accidental poisoning.