Aluminium phosphide poisoning ispoisoning that occurs as a result of excessive exposure toaluminium phosphide (AlP), which is readily available as afumigant for stored cereal grains and sold under various brand names such asQuickPhos,Salphos andCelphos. Aluminium phosphide is highly toxic, especially when consumed from a freshly opened container.^[1][2] Acute aluminium phosphide poisoning (AAlPP) is a large though under-reported problem throughout the world, particularly in theIndian subcontinent.

After ingestion, toxic features usually develop within a few minutes. The major lethal consequence of aluminium phosphide ingestion is profoundcirculatory collapse, and is reportedly secondary to these toxins generated, which lead due to direct effects oncardiomyocytes,^[3] fluid loss, and adrenal gland damage.^[4] The signs and symptoms are non-specific, dose dependent and evolve with time passing. The dominant clinical feature is severehypotension refractory todopamine therapy.^[5] Other features may include dizziness, fatigue, tightness in the chest, headache,nausea, vomiting,diarrhoea,ataxia, numbness,paraesthesia, tremor, muscle weakness,diplopia andjaundice.^[6][7][8][9] If severe inhalation occurs, the patient may developacute respiratory distress syndrome (ARDS),heart failure,arrhythmias,convulsion andcoma. Late manifestation include liver and kidney toxicities.^[6][7][8][9] Death can result from profound shock,myocarditis andmulti-organ failure.^[10]

The diagnosis of AAlP usually depends on the clinical suspicion or history (self-report or by attendants). In some nations, tablets of AlP are also referred to as "rice tablets" and, if there is a history of rice tablet ingestion, then it should be treated differently from other types of rice tablets that are made up of herbal products.^[11] For asilver nitrate test on gastric aspirate, diluted gastric content can be positive.^[4]

The toxicity of aluminium phosphide is attributed to the liberation ofphosphine gas, acytotoxic compound that causesfree radical mediated injury, inhibits vital cellular enzymes and is directly corrosive to tissues. The following reactions release phosphine when AlP reacts with fluids in the body:

AlP + 3 H₂O → Al(OH)₃ + PH₃, and

AlP + 3 HCl → AlCl₃ + PH₃ (stomach)

The management of AAlPP remains purely supportive because no specific cure exists.^[12] Mortality rates approach 60%. Correction ofmetabolic acidosis is a cornerstone of treatment.^[13] The role ofmagnesium sulfate as a potential therapy in AlP poisoning may decrease the likelihood of a fatal outcome, and has been described in many studies.^[10][9]

Aluminium phosphide has a fatal dose of between 0.15 and 0.5 grams (0.0053 and 0.0176 oz).^[14] The mortality rates from AAlPP vary from 35 to 85 percent.^[15] The actual numbers of cases may be much larger, as less than five percent of those with AAlPP eventually reach a tertiary care center.^[10] Since 1992, when aluminium phosphide became freely available in the market, it had, reportedly, overtaken all other forms of deliberate poisoning, such asorganophosphorus andbarbiturate poisoning, in North India.^[16] In a 25-year-long study on 5,933unnatural deaths in northwest India, aluminium phosphide poisoning was found to be the major cause of death among all cases of poisonings.^[17]

It has been reported to be the most common method of suicidal death inNorth India.^[18][19]

Deaths have also been reported inIran.^[20]

In January 2017, four children died at atrailer park inAmarillo, Texas, after the pesticide was used under the home to kill rats.^[21]

Several incidents of death in travelers inThailand and other parts ofSoutheast Asia may have been caused by aluminum phosphide orchlorpyrifos, anorganophosphate insecticide, used in an attempt to killbedbugs in hotels.^[22][23]

On November 16 2019, 2 children and an adult were killed inTimișoara,Romania, after the residential complex they were living in had been improperly vented after fumigation with AlP. It was later found there were other cases in the country that could have been linked to the misuse of this chemical.^[24]

In February 2020, aluminum phosphide poisoning resulted in one death and three serious injuries aboard a cargo ship traveling near France,^[25] as the result of a botched fumigation procedure.^[26]

In December 2021, an 11-year old girl died in London and another child was seriously injured byphosphine inhalation after a neighbour used illegally imported aluminum phosphide tablets in an attempt to remove a bedbug infestation in an apartment building.^[27]

TheCDC has classifiedphosphine as immediately dangerous to life at 50parts per million.^[28] In a study from Saudi Arabia, poisoning was most common during fumigation of households.^[29]

• Aluminium
• Poisoning and certain other consequences of external causes
• Toxins
• Toxic effects of metals
• Phosphorus

• Articles with short description
• Short description matches Wikidata