The Potential Therapeutic Role of Hydroxyethyl Starch and Hydrocortisone in Acute Aluminum Phosphide Poisoning
The Potential Therapeutic Role of Hydroxyethyl Starch and Hydrocortisone in Acute Aluminum Phosphide Poisoning
Aluminum phosphide (ALP) is a widely used fumigant due to its efficiency as pesticides. It is
 available as tablets of Celphos, Alphos or Quickphos which are known as rice tablets. Each
 tablet weights 3 grams and contains 56% ALP and 44% of aluminum carbonate and paraffin. The
 incidence of ALP poisoning increased steadily specially in developing countries . ALP
 poisoning is considered to be one of the major causes of suicidal poisoning owing to its wide
 accessibility and low cost. However, accidental poisoning may occur during occupational
 exposure
Aluminum phosphide (ALP) is a widely used fumigant due to its efficiency as pesticides. It is
 available as tablets of Celphos, Alphos or Quickphos which are known as rice tablets. Each
 tablet weights 3 grams and contains 56% ALP and 44% of aluminum carbonate and paraffin. The
 incidence of ALP poisoning increased steadily specially in developing countries . ALP
 poisoning is considered to be one of the major causes of suicidal poisoning owing to its wide
 accessibility and low cost. However, accidental poisoning may occur during occupational
 exposure.

 Signs and symptoms of acute AlP poisoning include gastrointestinal, cardiovascular, hepatic,
 renal, and neurologic (1). Ingestion of ALP causes mild gastrointestinal (GIT) manifestations
 as nausea, vomiting, abdominal pain, in addition to chest tightness, hypotension, headache
 and dizziness. In severe cases, GIT hemorrhage, shock, severe metabolic acidosis, cardiac
 arrhythmia, convulsions and coma may occur. Later, signs of hepatic damage and renal
 insufficiency may develop.

 Death usually occurs in 30-70% of cases within the first 24 hours resulting from refractory
 cardiogenic shock, cardiac arrhythmia, severe hypotension and metabolic acidosis.The main
 causes of cardiovascular collapse are increase capillary permeability, insufficient systemic
 vasoconstriction with low ventricular ejection fraction. On autopsy examinations, point to
 extravasation of fluid into the third space.

 The management is exclusively supportive as gastric lavage with KMnO4 solution, treatment of
 hypotension and acidosis in view of the fact that there is no specific antidote available.
Inclusion Criteria:

 -  Patients with severe acute aluminum phosphide poisoning

 -  systolic blood pressure (SBP) ≤90 mmHg

 -  PH ≤ 7.2

 -  HCO3 ≤15 meq/L

 -  during the first six hours of admission

 Exclusion Criteria:

 -  Pregnant and lactating women

 -  Asymptomatic patients with history of acute aluminum phosphide exposure.

 -  Patients with co-ingestion to other substances in addition to aluminum phosphide.

 -  Patients with other major medical conditions (e.g. cardiovascular disease, renal or
 hepatic failure).

 -  Patients with previous medical intervention (fluid therapy and vasopressors).