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Phosphine Poisoning

Phosphine Toxicity


Presentation

  • A case compatible with an acute phosphine poisoning after inhalation is presented.[ncbi.nlm.nih.gov]
  • After an initial presentation of respiratory distress, the 15-month-old toddler progressed to complete cardiopulmonary collapse and did not survive despite aggressive intervention including extracorporeal membrane life support.[journals.lww.com]
  • .; licensee BioMed Central. 2015 Received: 1 September 2014 Accepted: 18 February 2015 Published: 1 March 2015 Abstract Objectives To determine accidental factors, clinical presentation and medical care in cases of seafarers presenting phosphine poisoning[occup-med.biomedcentral.com]
  • Phosphine gas when interact with moisture present in the lungs form phosphoric acid that causes blistering, edema and adult respiratory distress syndrome (ARDS).[medimoon.com]
Fatigue
  • Slight or mild poisoning may give a feeling of fatigue, ringing in the ears, nausea, pressure in the chest and uneasiness. All of these symptoms will normally disappear in fresh air.[fao.org]
  • Fatigue, muscle pain, chills, tremors, incoordination, seizures, and coma may be seen. Pulmonary edema and cardiac arrhythmias are common. Gastrointestinal symptoms include nausea, vomiting, abdominal pain, and diarrhea.[cameochemicals.noaa.gov]
  • Nervous system effects include headache, restlessness, irritability, dizziness, lethargy, drowsiness, fatigue, loss of feeling, impaired gait, trembling of the extremities during movement, and double vision.[cdc.gov]
Pathologist
  • The slides of liver specimens of the cases were retrieved and studied separately by two pathologists. The poisoning was suicidal in 33 (86.5%) of cases.[ncbi.nlm.nih.gov]
Veterinarian
  • Veterinarians caring for animals [ 24 ] and health workers caring for people who have absorbed aluminium phosphide can also come into contact with generated phosphine gas [ 25 ].[occup-med.biomedcentral.com]
Nausea
  • Faintness, apathy, nausea, weakness, dyspnea, vomiting, a fall in blood pressure, diarrhea, change in heartbeat rate, intense thirst, tightness in chest, paralysis, convulsions and coma are all symptoms of Phosphine poisoning.[praxairdirect.com]
  • Notable features of these cases: All 6 members of the family household developed nausea and malaise after placement of the AlP pellets, and were diagnosed with food poisoning.[thepoisonreview.com]
  • Two were kept overnight for observation because of headache and nausea but were in good condition Tuesday, he said.[nbcdfw.com]
  • Signs of phosphine toxicity include: rapid and/or irregular heart rate, low blood pressure, shock, nausea, abdominal pain, vomiting, diarrhea and cardiac arrest. www.OEHHA.CA.Gov.[ksl.com]
  • Other symptoms of poisoning from inhalation are: coughing, chest tightness and headache double vision and dizziness nausea and vomiting. Exposure may also lead to anaemia, bronchitis, diarrhoea and visual, speech and motor disturbances.[worksafe.qld.gov.au]
Abdominal Pain
  • Signs of phosphine toxicity include: rapid and/or irregular heart rate, low blood pressure, shock, nausea, abdominal pain, vomiting, diarrhea and cardiac arrest. www.OEHHA.CA.Gov.[ksl.com]
  • Table: Overview of different targeted systems and their possible sign and symptoms Targeted System Sign and Symptoms Gastrointestinal tract (GIT) Abdominal pain, cramps, nausea, vomiting, burning Cardiovascular system (CVS) Shock, heart failure, hypotension[medimoon.com]
  • Gastrointestinal symptoms include nausea, vomiting, abdominal pain, and diarrhea. Renal (kidney) damage, hepatic (liver) damage, and jaundice may also occur. Contact with phosphine may burn the skin and eyes.[cameochemicals.noaa.gov]
  • Gastrointestinal effects include nausea, vomiting (emesis), diarrhea, abdominal pain, gastrointestinal distress, and liver injury. General effects include sweating and bluish discoloration of the skin (cyanosis). Severe: Death.[cdc.gov]
Hypotension
  • The dominant clinical feature is severe hypotension refractory to dopamine therapy. Diagnosis depends on the clinical suspicion. Silver nitrate test on gastric aspirate can be positive.[emnote.org]
  • Pressor agents may be required to treat hypotension, bradycardia, and renal failure.[emedicine.medscape.com]
  • Monitor heart function, and evaluate for low blood pressure (hypotension), abnormal heart rhythms (dysrhythmias), and reduced respiratory function (respiratory depression).[cdc.gov]
  • Table: Overview of different targeted systems and their possible sign and symptoms Targeted System Sign and Symptoms Gastrointestinal tract (GIT) Abdominal pain, cramps, nausea, vomiting, burning Cardiovascular system (CVS) Shock, heart failure, hypotension[medimoon.com]
Retrosternal Chest Pain
  • Symptoms including retrosternal chest pain had lasted for several minutes the previous day. Clinical examination was normal and the ECG showed a banal right bundle branch block. He was kept in for observation for twenty-four hours.[occup-med.biomedcentral.com]
Palpitations
  • He was advised to consult again quickly should palpitations, difficulties breathing or chest pain reoccur in the following few days. For the eight other patients, clinical examinations, biological results, chest x-rays and ECGs were normal.[occup-med.biomedcentral.com]
Heart Disease
  • Clinical Guide to Bioweapons and Chemical Agents pp 375-379 Cite as Chapter 87 Downloads Keywords Public Health Heart Disease Congestive Heart Failure Emergency Medicine Pulmonary Edema These keywords were added by machine and not by the authors.[link.springer.com]
Anger
  • View Article Google Scholar Anger F, Paysant F, Brousse F, Le Normand I, Develay P, Gaillard Y, et al. Fatal aluminum phosphide poisoning. J Anal Toxicol. 2000;24(2):90–2. View Article PubMed Google Scholar Yadav J, Athawal BK, Dubey BP, Yadav VK.[occup-med.biomedcentral.com]
Headache
  • Two were kept overnight for observation because of headache and nausea but were in good condition Tuesday, he said.[nbcdfw.com]
  • Other symptoms of poisoning from inhalation are: coughing, chest tightness and headache double vision and dizziness nausea and vomiting. Exposure may also lead to anaemia, bronchitis, diarrhoea and visual, speech and motor disturbances.[worksafe.qld.gov.au]
  • Specific clinical information being looked for in these consultations and examinations were the following: any medical history, presence or not of neurological signs (headaches, dizziness and abnormalities in the neurological examination); digestive signs[occup-med.biomedcentral.com]
  • Signs and Symptoms of Acute Phosphine Exposure: Acute exposure to phosphine usually results in headache, cough, tightness and pain in the chest, shortness of breath, dizziness, lethargy, and stupor.[cameochemicals.noaa.gov]
  • Nervous system effects include headache, restlessness, irritability, dizziness, lethargy, drowsiness, fatigue, loss of feeling, impaired gait, trembling of the extremities during movement, and double vision.[cdc.gov]

Treatment

  • As there is no specific treatment and taking into consideration current knowledge on this subject (even if types of protective treatment are under discussion), only symptomatic treatment to sustain vital organ function is possible.[occup-med.biomedcentral.com]
  • Treatment of Adult Respiratory Distress Syndrome: Deliver oxygen via face mask at a rate of 5-10 liters/min. Mechanical support can also be provided if necessary.[medimoon.com]
  • To date there has been no report of appreciable adverse effects from recommended treatments.[fao.org]
  • Treatment includes early gastric lavage with potassium permanganate or a combination of coconut oil and sodium bicarbonate, administration of charcoal and palliative care.[esim.eg.net]
  • The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber.[medicinesinpregnancy.org]

Prognosis

Epidemiology

  • Epidemiologic, clinical, and pathological findings. JAMA. 1980;244(2):148–50. View Article PubMed Google Scholar Preisser AM, Budnik LT, Baur X. Health effects due to fumigated freight containers and goods: how to detect, how to act.[occup-med.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Until now, case reports as well as anatomical, pathological post-mortem studies have not completely identified the pathophysiological phenomena involved [ 26 - 29 ], even if animal experimentation seems to point to mitochondrial respiratory chain inhibition[occup-med.biomedcentral.com]

Prevention

  • To consider primary prevention of this pathology, which can have extremely severe consequences. Methods To analyse circumstances resulting in toxic exposure to phosphine in the sea transport sector.[occup-med.biomedcentral.com]
  • Store canisters correctly to prevent deterioration of the tablets, thereby reducing explosion potential. Keep them in a cool, dry place away from all habitation.[worksafe.qld.gov.au]
  • Prevent entry into waterways, sewers, basements or confined areas. Isolate area until gas has dispersed.[cameochemicals.noaa.gov]
  • Tomelukast, a leukotriene receptor antagonist, prevents pulmonary edema in phosgene-exposed rabbits.[emedicine.medscape.com]
  • Department for Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 94-113. OSHA [1991].[cdc.gov]

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