Gastric decontamination in aluminum phosphide poisoning: Narrative review
Keywords:
Aluminum Phosphide Poisoning, Gastric Lavage, Olive Oil, Coconut OilAbstract
Background: Despite significant progress in toxicology, there is no particular antidote for aluminum phosphide poisoning and the consequences of PH3 gas toxicity. While several researchers have concentrated on the technicalities of supportive intravenous treatment using various medicines such as sodium bicarbonate, Glucose-insulin-potassium protocol, and Digoxin or other methods; new research is attempting to enhance our interventions in the pre-absorption phase of phosphine gas. Methods: A narration of literature.
Results: Some researchers are completely opposed to gastric decontamination using water-based solutions, the use of essential oils is proposed to avoid excessive PH3 release. In this study, we reviewed the literature for oil-based gastric decontamination methods. Based on our review, liquid paraffin might improve outcomes of ALP poisoning but it might be associated with adverse events. Evidence about coconut oil is still controversial which might be due to the co-administration of sodium bicarbonate in gastric lavage. Aloe vera, olive oil, and almond oil in gastric lavage have shown impressive benefits, but more evidence is needed.
Conclusion: To conclude, oil-based gastric lavage is associated with less mortality, and water-soluble washing methods and activated charcoal administration should be avoided.
Declarations:
Acknowledgment:
We would like to thank the Clinical Research Development Unit of Peymanieh Educational and Research and Therapeutic Center of Jahrom University of Medical Sciences for providing facilities for this work.
Authors Contributions:
NS: Contributed to the review by conducting a comprehensive literature search and identifying relevant studies for inclusion.
SA: Provided expertise in the topic area and helped conceptualize the review's framework and scope. Contributed to the critical evaluation of the studies included and helped draft the manuscript.
FR: Conducted a thorough review of the literature and extracted data from the studies included in the review. Also contributed to the analysis and interpretation of the results, and helped revise the manuscript.
RS: Provided insight into the clinical implications of the review's findings, as well as practical recommendations for healthcare providers. Contributed to the final editing and formatting of the manuscript.
Conflict of interest:
There are no conflicts of interest in this study.
Research funding: None.
Data availability: No data are available for this review study.
References
Hosseini SF, Forouzesh M, Maleknia M, Valiyari S, Maniati M, Samimi A. The molecular mechanism of aluminum phosphide poisoning in cardiovascular disease: Pathophysiology and diagnostic approach. Cardiovascular Toxicology. 2020 Oct;20(5):454-61.
Jaiswal S, Verma RK, Tewari N. Aluminum phosphide poisoning: Effect of correction of severe metabolic acidosis on patient outcome. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2009 Jan;13(1):21.
Karimani A, Mohammadpour AH, Zirak MR, Rezaee R, Megarbane B, Tsatsakis A, Karimi G. Antidotes for aluminum phosphide poisoning–an update. Toxicology reports. 2018 Jan 1;5:1053-9.
Katira R, Elhence GP, Mehrotra ML, Srivastava SS, Mitra A, Agarwala R, Ram A. A study of aluminum phosphide (AlP) poisoning with special reference to electrocardiographic changes. The Journal of the Association of Physicians of India. 1990 Jul 1;38(7):471-3.
Sheta AA, El-Banna AS, Abd Elmeguid R, Mohamed HE, Gad NH. A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score. Environmental Science and Pollution Research. 2019 Nov;26(32):33135-45.
Lu MF, Nie SN. Progress in treatment of acute aluminum phosphide poisoning. Zhonghua lao dong wei sheng zhi ye bing za zhi= Zhonghua laodong weisheng zhiyebing zazhi= Chinese journal of industrial hygiene and occupational diseases. 2019 Nov 1;37(11):877-80.
Ghimire R, Utyasheva L, Pokhrel M, Rai N, Chaudhary B, Prasad PN, Bajracharya SR, Basnet B, Das KD, Pathak NK, Baral MP. Intentional pesticide poisoning and pesticide suicides in Nepal. Clinical toxicology. 2021 Jun 11:1-7.
Ramadan N. Aluminum phosphide poisoning; a case of survival. Asia Pacific Journal of Medical Toxicology. 2019 Mar 1;8(1):28-9.
Bashardoust B, Farzaneh E, Habibzadeh A, Sadeghi MS. Successful treatment of severe metabolic acidosis due to acute aluminum phosphide poisoning with peritoneal dialysis: a report of 2 cases. Iranian journal of kidney diseases. 2017 Mar 1;11(2):165.
Pannu AK, Bhalla A, Gantala J, Sharma N, Kumar S, Dhibar DP. Glucose-insulin-potassium infusion for the treatment of acute aluminum phosphide poisoning: an open-label pilot study. Clinical Toxicology. 2020 Oct 2;58(10):1004-9.
Oghabian Z, Mehrpour O. Treatment of aluminium phosphide poisoning with a combination of intravenous glucagon, digoxin and antioxidant agents. Sultan Qaboos University Medical Journal. 2016 Aug;16(3):e352.
Neuvonen PJ, Olkkola KT. Oral activated charcoal in the treatment of intoxications. Medical toxicology and adverse drug experience. 1988 Feb;3(1):33-58.
Mirakbari SM. Hot charcoal vomitus in aluminum phosphide poisoning-A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature. Indian journal of anaesthesia. 2015 Jul;59(7):433.
Agrawal VK, Bansal A, Singh RK, Kumawat BL, Mahajan P. 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. 2015 Feb;19(2):109.
Hashemi-Domeneh B, Zamani N, Hassanian-Moghaddam H, Rahimi M, Shadnia S, Erfantalab P, et al. A review of aluminium phosphide poisoning and a flowchart to treat it. Arh Hig Rada Toksikol 2016;67:183-93. doi: 10.1515/aiht2016-67-2784
Sanaei-Zadeh H, Mahdi Marashi S. Gastric decontamination in aluminium phosphide poisoning: a case against the use of water-based solutions. Arhiv za higijenu rada i toksikologiju. 2016 Dec 14;67(4):364-5.
Shadnia S, Rahimi M, Pajoumand A, Rasouli MH, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: Possible benefit of coconut oil. Hum Exp Toxicol. 2005;24:215–8.
Harned HS, Davis Jr R. The ionization constant of carbonic acid in water and the solubility of carbon dioxide in water and aqueous salt solutions from 0 to 50. Journal of the American Chemical Society. 1943 Oct;65(10):2030-7.
Perry HE. Rodenticides. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester’s clinical management of poisoning and drug overdose. Philadelphia, PA: Saunders – Elsevier; 2007: 1218, 1225–6.
Borron SW, Burns MJ. Haddad and Winchester's clinical management of poisoning and drug overdose. Saunders/Elsevier,; 2007. Mirakbari SM. Hot charcoal vomitus in aluminum phosphide poisoning-A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature. Indian journal of anaesthesia. 2015 Jul;59(7):433.
Sharif F, Crushell E, O'driscoll K, Bourke B. Liquid paraffin: a reappraisal of its role in the treatment of constipation. Archives of disease in childhood. 2001 Aug 1;85(2):121-4.
Darwish RT, Sobh ZK, Hamouda EH, Saleh EM. The efficacy of Coenzyme Q10 and liquid paraffin oil in the management of acute aluminum phosphide poisoning. Toxicology Research. 2020 Jul;9(4):444-53.
Goswami M, Bindal M, Sen P, Gupta SK, Avasthi R, Ram BK. Fat and oil inhibit phosphine release from aluminium phosphide--its clinical implication. Indian journal of experimental biology. 1994 Sep 1;32(9):647-9.
J.K. Aronson. Paraffins. Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions (Fifteenth Edition),Elsevier, 2006,Pages 2693-2697, ISBN 9780444510051, https://doi.org/10.1016/B0-44-451005-2/01478-9.
Singh Bajwa SJ, Bajwa Kaur SK, Kaur J, Singh K, Panda A. Management of celphos poisoning with a novel intervention: A ray of hope in the darkest of clouds. Anesth Essays Res. 2010;4:20–4.
Saidi H, Shojaie S. Effect of sweet almond oil on survival rate and plasma cholinesterase activity of aluminum phosphide-intoxicated rats. Human & experimental toxicology. 2012 May;31(5):518-22.
Dayananda VP, Satish Kumar MN, Rakesh Kumar B. Coconut oil as an adjuvant to magnesium sulphate therapy in acute aluminum phosphide consumption. Int J Anesth Res. 2018 Feb 27;6(2):509-14.
Pajoumand A, Jalali N, Abdollah M, Shadnia S. Survival following severe aluminium phosphide poisoning. Journal of Pharmacy Practice and Research. 2002 Dec;32(4):297-9.
Maleki A, Hosseini MJ, Rahimi N, Abdollahi A, Akbarfakhrabadi A, Javadian N, Amiri S, Behnoush B, Dehpour AR. Adjuvant potential of selegiline in treating acute toxicity of aluminium phosphide in rats. Basic & clinical pharmacology & toxicology. 2019 Jul;125(1):62-74.
Devi KJ, Soreingam K, Singh VK. Role of coconut oil and soda bicarbonate in gastric lavage in the management of celphos poisoning. Journal of Health Research and Reviews. 2016 Jan 1;3(1):31.
Ghosh S, Biswajit M, Chatterjee PK, Saurabh S, Sudeep KN, Shukla P, Sharmistha C. Aluminum Phosphide Poisoning Presenting like Acute Myocardial Infarction in a Young Girl. The Journal of the Association of Physicians of India. 2018 Oct 1;66(10):92-3.
Vaidyanathan R, Hg A, Noor A, Adarsh S. Comparative study of management of aluminium phosphide poisoning-our experience. J Evid Based Med Healthcare. 2020;7:2349-562.
Rahimi N, Abdolghaffari AH, Partoazar A, Javadian N, Dehpour T, Mani AR, Dehpour AR. Fresh red blood cells transfusion protects against aluminum phosphide-induced metabolic acidosis and mortality in rats. PloS one. 2018 Mar 28;13(3):e0193991.
Shakeri M, Soroosh D, Shakeri H, Kalani N, Hatami N, Foroughian M. Successful Treatment of Acute Aluminum Phosphide Poisoning by Aloe Vera Syrup: A Case Report. International Journal of Medical Toxicology and Forensic Medicine. 2021;11(2):33016-.
Mahor G, Ali SA, Parveen N. Aloin from Aloe Vera leaves: A potential natural aluminium detoxificant. Biosci Biotech Res Comm. 2019;12(2):531-8.
Leung PC, Siu WS, Erik CH. A Food Supplement with Lead Chelating Effects: A Preliminary Study. J Heavy Met Toxicity Dis. 2017;2:1.
Jakkala, Laxman K. “Aloe vera protects the aluminium induced degenerative changes in liver and kidney of albino rats , Rattus norvegicus.”, Journal of Global Biosciences. Vol. 4(8), 2015 pp. 3158-3164.
Mohammad Hossien Kamaloddini, Parvin Zohoorian, Mahdi Foroughian , Sara Hemmati Awli, Ali Teimouri. Successful Treatment of Acute Aluminum Phosphide Poisoning: Possible Benefit of Olive Oil-A Case Report. Updates in Emergency Medicine, 2021; 1(1).
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