Global & Disaster Medicine

Archive for the ‘Aluminium phosphide’ Category

Un matrimonio burgalés, última víctima del fosfuro de aluminio

El Espanol


Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emergency Medicine Journal : EMJ. 2006;23(1):e3. doi:10.1136/emj.2004.015941.
“A previously well 41 year old Indian woman presented 2 hours after ingestion of a 10 g sachet of Fumino (aluminium phosphide (AlP) 56% w/w; United Phosphorus) mixed with water. She was distressed, vomiting, and had severe epigastric pain with blood pressure 70/58 mmHg, pulse 100 beats/min, oxygen saturation 86% on air, and temperature 37.1°C. Arterial blood gases (ABG) on 10 l/min oxygen showed pO2 37.7 kPa, pCO2 3.04 kPa, pH 7.27, bicarbonate 13.2 mmol/l, and base excess (BE) −14.4. Chest x ray showed bilateral pulmonary infiltrates and ECG a sinus tachycardia (fig 1A1A).). She was treated with intravenous colloid (1 litre Gelofusion over 30 minutes), 200 mg hydrocortisone, 40 mg pantoprazole, 300 mg phenytoin, and 50 mmol sodium bicarbonate. Infusions of N‐acetylcysteine (6.5 g over 24 h) and magnesium sulphate (70 mmol/l over 24 hours) were commenced. She remained hypotensive and her clinical condition deteriorated with worsening hypoxia and metabolic acidosis (ABG on 15 l/min O2: pO2 10.6 kPa, pCO2 4.24 kPa, pH 7.16, bicarbonate 12 mmol/l, BE –16). She was paralysed, intubated, and ventilated. Metabolic acidosis was treated with 50 mmol/h sodium bicarbonate but despite fluid resuscitation, she required norepinephrine and later epinephrine infusion (maximum 3 µg/kg/min) to maintain blood pressure. Continuous venous–venous haemofiltration was commenced in an attempt to correct the acidosis. A portable echocardiograph (Sonoheart Elite) showed normal left ventricle (LV) size with moderately impaired LV function and cardiac index of 1.5 l/min/m2. A broad complex tachycardia (fig 1B1B)) occurred, which was treated with amiodarone (300 mg over 1 hour). Serial creatinine kinase, and amylase were within normal limits. Subsequently she developed disseminated intravascular coagulation and adult respiratory distress syndrome. Despite supportive management she died 36 hour after admission.”


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