Phosphine inhalation, case series of domestic unintentional poisoning commonly used as anti-bed bug chemical from a low income country

Authors

  • Badar Afzal Department of Emergency Medicine, Aga Khan University, Karachi
  • Emaduddin Siddiqui Department of Emergency Medicine, Aga Khan University, Karachi
  • Ghazala Irfan Kazi Department of Emergency Medicine, Aga Khan University, Karachi
  • Irum Qamar Khan Department of Emergency Medicine, Aga Khan University, Karachi
  • Muhammad Daniyal Department of Emergency Medicine, Aga Khan University, Karachi
  • Muhammad Abdul Raffay Khan Department of Emergency Medicine, Aga Khan University, Karachi

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20183113

Keywords:

Phosphine, Insecticides, Accidental poisoning

Abstract

Phosphine poisoning is an uncommon but hazardous public health issue. It is widely used chemical compound as insecticides domestically and exposure to this chemical is mostly accidental especially in children, which may lead to fatal symptoms if not managed immediately. Previous studies have explored the mechanism of its deleterious effect. However, literature on presentation of phosphine poisoning is sparse. Medical records, from January 2005 to September 2013, with patients presenting to ED of Aga Khan University Hospital were reviewed after successfully taking ERC approval from the hospital. Patients with confirm phosphine poisoning were identified and further details were noted from their medical records. We identified seven cases of phosphine poisoning during the study period. Majority patients presented with generalized weakness, diarrhea, vomiting and drowsiness after exposure to phosphine containing insecticides, mostly exposed within past two days of symptoms and presentation. Six out of seven patients were successfully managed and discharged while one of the patient couldn't be saved. The objective of this study was to investigate various presentations of phosphine poisoning to Emergency Department (ED) in a low-income setting in Karachi, Pakistan and bring it to attention of the need to replace insecticides with a safer chemical compound and keep children out of reach from such toxins. Moreover increase awareness program and proper labeling and precautions should be written on all commonly sold pesticides and the constituent of hazardous compounds they contain.

References

Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh Hig Rada Toksikol. 2012;63(1):61-73.

Alert N. Preventing phosphine poisoning and explosions during fumigation. DHHS (NIOSH) Publication; 1999: 6.

Shadnia S, Soltaninejad K, Sadeghi A, Rahimzadeh H, Zamani N, Ghasemi-Toussi A, et al. Methemoglobinemia in aluminum phosphide poisoning. Human Experimental Toxicol. 2011;30(3):250-3.

Abder-Rahman HA. Alumnium phosphide fatalities at mild exertion in asymptomatic children: A clue to understand the variations of the autopsy findings. J Forensic Legal Med. 2009;16(6):312-5.

Kumar A, Chaudhari S, Kush L, Kumar S, Garg A, Shukla A. Accidental inhalation injury of phosgene gas leading to acute respiratory distress syndrome. Indian J Occupational Environ Med. 2012;16(2):88-9.

Gupta S, Ahlawat SK. Aluminum phosphide poisoning-a review. Clin Toxicol. 1995;33(1):19-24.

Memis D, Tokatlioglu D, Koyuncu O, Hekimoglu S. Fatal aluminium phosphide poisoning. Eur J Anaesthesiol. 2007;24(3):292-3.

Sudakin DL. Occupational exposure to aluminium phosphide and phosphine gas? A suspected case report and review of the literature. Hum Exp Toxicol. 2005;24:27-33.

Senarathna L, Jayamanna S, Kelly P, Buckley N, Dibley M, Dawson A. Changing epidemiologic patterns of deliberate self poisoning in a rural district of Sri Lanka. BMC Public Health. 2012;12(1):593.

Nocera A, Levitin HW, Hilton JM. Dangerous bodies: a case of fatal aluminium phosphide poisoning. Med J Australia. 2000;173(3):133-5.

Singh S, Wig N, Chaudhary D, Sood NK, Sharma BK. Changing pattern of acute poisoning in adults: Experience of a large North-West Indian Hospital (1970-1989). J Association of Physicians of India. 1997;45(3):194-7.

Anger FO, Paysant F, Brousse F, Le Normand I, Develay P, Galliard Y, et al. Fatal aluminum phosphide poisoning. J Analytical Toxicol. 2000;24(2):90-2.

Mehrpour O, Singh S. Rice tablet poisoning: a major concern in Iranian population. Hum Exp Toxicol. 2010;29(8):701-2.

Jørgensen JR, Rössel PR. Poisoning with aluminumphosphide can be life-threatening for patients as well as health professionals. Ugeskrift for laeger. 2013;175(24):1706.

Hosseinian A, Pakravan N, Rafiei A, Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran. Indian J Med Sci. 2011;65(4):143-50.

Nosrati A, Karami M, Esmaeilnia M. Aluminum phosphide poisoning: A case series in north Iran. Asia Pacific J Med Toxicol. 2013;2(3):111-3.

TaghaddosiNejad F, BanagozarMohammadi A, Behnoush B, Kazemifar A, ZaareNahandi M, Dabiran S, et al. Predictors of poor prognosis in aluminum phosphide intoxication. Iranian J Toxicol. 2012;6(16):610-4.

Agrawal VK, Bansal A, Singh RK, Kumawat BL, Mahajan P. Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Med. 2015;19(2):109.

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Published

2018-07-23

How to Cite

Afzal, B., Siddiqui, E., Kazi, G. I., Khan, I. Q., Daniyal, M., & Khan, M. A. R. (2018). Phosphine inhalation, case series of domestic unintentional poisoning commonly used as anti-bed bug chemical from a low income country. International Journal Of Community Medicine And Public Health, 5(8), 3643–3646. https://doi.org/10.18203/2394-6040.ijcmph20183113

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Section

Case Reports