Mechanism of action of poisoning with aluminum phosphide (rice pills), its complications and methods of treatment

Introduction: Aluminum phosphide (ALP) or rice pills are used as pesticides, insecticides and rodents for the preservation of beans, cereals and rice in agriculture. It produces phosphine gas in close proximity to air, water and stomach acid, which is highly toxic and flammable. The aim of this study was to investigate the mechanism of action of aluminum phosphide intoxication, its complications and treatment methods.Methods: This article is a review article and has been extracted by searching the web sites www.irandoc.ac.ir, www.iranmedex.com www.magiran.com and www.sid.ir.Results: Early symptoms of intoxication include abdominal pain, nausea and vomiting, cyanosis, and decreased consciousness due to hypoxia of the brain due to the reaction of phosphine with cytochrome c and cytochrome oxidase, reduced number or depth of respiration and increased arterial carbon dioxide pressure. Delayed symptoms include pulmonary edema, aspirated pneumonia, anemia, bronchitis, meth hemoglobinemia, liver failure, and renal damage due to lipid peroxidation, increased superoxide dismutase activity and decreased catalase level. The risk of death increases with systolic blood pressure below 90 mmHg, pH below 7.2, bicarbonate lower than 17, and blood oxygen saturation below 90%.Conclusion: In the face of aluminum phosphide poisoning rapid transfer to treatment centers, gastric lavage with 1: 10,000 potassium permanganate solution as oxidant and intravenous administration of 3% sodium bicarbonate, 10% calcium gluconate and 25% magnesium sulfate solutions. The main actions are cell membrane stabilization, oral administration of coconut oil as a toxin absorber, rapid analysis of arterial blood gases, laboratory tests to evaluate sodium, potassium, calcium, magnesium and electrocardiography. Finally, strict monitoring of the distribution of these pesticides and drugs and, more importantly, social and psychological support in the community, especially young people, is recommended.

Keywords:

Toxicity , Aluminum phosphide , Rice tablets , Complications , Treatment