Aluminum phosphide ingestion - A clinico-pathologic study

Background: Aluminum phosphide is widely used in India as a fumigant to protect stored grain from pests and rodents. It is marketed in India as 3 g tablets under several brand names as Celphos, Phostek, Quickphos, and Phosphume. If ingested, it is acutely toxic with a high mortality. The present study was undertaken to define any factors which could predict the outcome after an ingestion. Methods: Between March 1989 and March 1994, 195 patients with aluminum phosphide ingestion were admitted to Nehru Hospital of the Postgraduate Institute of Medical Education and Research, Chandigarh in Northwest India. The information regarding demography, time elapsed between ingestion and arrival in the hospital, nature of ingestion, dose ingested, symptoms and signs at admission and course during hospital stay was recorded on a proforma. Results: Of 195 patients, 115 died. The deaths could be related to the dose ingested but not to the time elapsed between ingestion and arrival at the hospital. The nonsurvivors had more severe hypotension and metabolic acidosis than the survivors who had more severe vomiting. Autopsies conducted in 115 subjects revealed congestion of liver, spleen, kidneys, adrenals, gastrointestinal tract and brain that correlated with the severity of hypotension. Histopathology did not reveal any specific changes beyond visceral congestion and patchy necrosis of the liver. Conclusion: Aluminum phosphide when ingested is highly toxic with fatal dose err low as 1.5 g. The dominant clinical feature is severe hypotension refractory to dopamine.