Update in the Management of Acute Aluminum Phosphide Poisoning: A Narrative Review

Abstract

Background: Aluminum phosphide is frequently used as a rodenticide and to preserve grain. There is a significant risk of aluminum phosphide self-poisoning because of its simple accessibility and lack of control. The fatality rate from aluminum phosphide intoxication is significant, and there is currently no known counteragent. There aren't many studies on aluminum phosphide poisoning in Ethiopia, despite its high frequency and fatality rate. This narrative review's aim is to elaborate existing and new approaches to treating acute aluminum phosphide poisoning.

Method: Eligibility criteria were set prior to the search. A comprehensive literature review was performed searching PubMed, Cochrane library and Google Scholar. The major focuses were on recent studies, clinical trials, and systematic reviews with both qualitative and quantitative aspects.

Results: Patients receiving glucose insulin and potassium therapy (GIK) had consistently lower mortality rates and fewer case fatalities than those receiving basic supportive care alone, according to prospective observational studies and randomized controlled trials (RCTs). By improving myocardial carbohydrate absorption and metabolism, GIK infusion helps the strained heart overcome the energy imbalance caused by phosphine poisoning. In the evaluated research, oil-based gastric lavage with agents like coconut oil or paraffin oil showed better results than conventional water-based lavage (e.g., with potassium permanganate). Numerous case studies demonstrate effective patient recoveries, enhanced cardiac function, and neurological outcomes, demonstrating the critical role of extracorporeal membrane oxygenation (ECMO) plays in saving lives. Antioxidants such as N-acetylcysteine (NAC), however, showed less consistent results. When paired with additional medications like Coenzyme Q10 or Vitamin E, several studies suggested possible advantages including increased survival rates, shorter hospital stays, or better results. L-carnitine also showed a non-significant tendency toward decreased mortality. Other cutting edge treatment options investigated for acute aluminum phosphide toxicity include Trimetazidine, liothyronine, and boric acid.

Conclusion: The fatality rate from aluminum phosphide intoxication is significant, and there is currently no known counteragent. While antioxidants like N-acetylcysteine have shown conflicting results and require more research, therapeutic approaches like glucose-insulin-potassium (GIK) infusion oil-based gastric lavage have demonstrated a considerable reduction in death rate.

Keywords: Aluminium Phosphide; Glucose-insulin-potassium; Coconut Oil

Citation

Ayele M, Ayenew KD. Update in the Management of Acute Aluminum Phosphide Poisoning: A Narrative Review. WebLog J Toxicol. wjt.2025. j2901. https://doi.org/10.5281/zenodo.17613766