Citation

Müssigbrodt A, Lauschke J, Horn GP, Grimm W, Maisch B. Intensivmedizin und Notfallmedizin 2007; 44(2): 110-115.

Copyright

(Copyright © 2007)

DOI

10.1007/s00390-006-0722-1

PMID

unavailable

Abstract

Aluminium phosphide is an extremely toxic chemical agent, which is widely used as a grain preservative by combating vermin, e.g. rats and mice. In case of intoxication the mortality is high, and can be as high as 75%. While the majority of intoxications is caused accidentally, there are also numerous instances of suicides and attempts thereof as well. 1 g in total or 10 mg/kg bodyweight of aluminium phosphide is reported as the potentially lethal dose for humans. In the literature, oral ingestion and intoxication by inhalation have already been described. As intravenous intoxication, on the other hand, has not yet been the subject of scientific report, we present this case report. A 36-year-old male, 180 cm in height, 72 kg in weight, was transferred with multiorgan failure and circulatory instability from an outside hospital to our ICU. Two hours before admission, the patient had injected 7.5 g of aluminium phosphide. At admission the patient was circulatory and respiratory instable. Laboratory findings depicted a multiorgan failure with renal and hepatic insufficiency. The patient was then temporarily stabilized with high doses of catecholamines. The ECG showed the morphologic appearance of a STEMI. Left ventricular ejection fraction was at 10% with normal cardiac diameters. As the intoxication had been caused by intravenous application, gastric rinsing was not performed. Neither the consultation of the toxicological center nor literature review could specify adequate therapy or antidote. Therefore, we could not offer therapeutic treatment apart from strictly supportive intensive care. The patient died 52 hours after intoxication. The autopsy showed multiorgan failure with renal and hepatic shock due to global cardiac insufficiency. Aluminium phosphide has crystalline appearance and grey colour. Dissolved in water phosphide deliberates phoshane (PH3) and diphosphane (P2H 4). Phosphane has an unpleasant, fish or garlic-like odour. Blocked activity of cytochrome oxidase and other antioxdative enzymes leads to decreased production of ATP and an increased release of reactive oxidative species and free radicals. Depending on the dose, dysfunction of all organs can occur, whereas injury of cardiac tissue seems to be of major influence for vital prognosis. Most patients present with dyspnoea and palpitations, thoracic and abdominal pain, nausea and vomiting, cyanosis, hypotension and shock. There is no established specific therapy. In cases of intoxications by ingestion, therapeutic measures should include elimination of the toxic agent by gastric rinsing and charcoal instillation. Considering intoxications by inhalation, corticoids are recommended. Apart from that, recognised therapy consists of strictly supportive intensive care therapy. The picture of a STEMI can be caused by intoxication with aluminium phosphide and should therefore be considered as a rare differential diagnosis where suicide is suspected. The extremely high lethality of intoxications with aluminium phosphide and the very limited medical therapeutic options should give rise to the question whether access to this poison should be more restricted. Further research to improve therapeutic means and thereby medical outcome is necessary. Producing industry should be held accountable and contribute to research in order to improve treatment and to eventually develop alternative toxic agents which are less dangerous for humans. © Steinkopff-Verlag 2007.

Language: de

Keywords

Intoxication; Aluminium phosphide; Multiorgan failure; Rodents toxine