Farahani Maryam Vasheghani, Soroosh Davood, Marashi Sayed Mahdi
Department of Forensic Medicine and Clinical Toxicology, AJA Medical School, AJA University of Medical Sciences, Tehran, Iran.
Department of Forensic Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Indian J Crit Care Med. 2016 Dec;20(12):724-730. doi: 10.4103/0972-5229.195712.
The majority of aluminum phosphide (ALP) toxicity cases are suicidal attempts. Despite advances in critical care medicine, the mortality rate of ALP remains very high. Unfortunately, knowledge on the toxicokinetics of ALP is very low. An obsolete idea was proposed that inhibition of complex IV of cytochrome C oxidase is responsible for multiorgan dysfunction. However, based on human studies, this effect might be insignificant. Thus, a novel idea proposes that the main mechanism might be vascular wall integrity disruption. The low frequency of acute toxicity and unanswered questions about the toxicokinetics and toxicodynamics has led to leaden advances of novel treatments. The aim of this review was to evaluate problems regarding current treatment protocols and propose new ideas based on updated information. For this purpose, we reviewed all available articles on the management of ALP poisoning published to date. Considering failure of conventional therapies on maintaining systolic blood pressure, correcting acid-base disturbances, and support cardiac function, the previous treatment protocols have been overruled. However, repudiate of conventional treatments in this deadly condition is not without penalties for the health-care provider. The introduction of new therapies including refuse of gastric lavage with water-soluble compounds, administration of a high molecular weight colloidal solution for fluid resuscitation and termination using sodium bicarbonate, and vasoactive agents has been prospected to improve patient survival. This protocol is in early clinical evaluation; nevertheless, it appears to improve patient's survival; hence, future randomized trials should be performed to support their effectiveness.
大多数磷化铝（ALP）中毒病例是自杀未遂。尽管重症医学取得了进展，但ALP中毒的死亡率仍然很高。不幸的是，关于ALP毒代动力学的知识非常有限。曾有一种过时的观点认为，细胞色素C氧化酶复合体IV的抑制是多器官功能障碍的原因。然而，基于人体研究，这种作用可能并不显著。因此，一种新观点认为主要机制可能是血管壁完整性破坏。急性中毒的发生率较低，以及关于毒代动力学和毒理学的问题尚未得到解答，导致新治疗方法的进展缓慢。这篇综述的目的是评估当前治疗方案存在的问题，并根据最新信息提出新观点。为此，我们查阅了迄今为止所有关于ALP中毒治疗的可用文章。鉴于传统疗法在维持收缩压、纠正酸碱紊乱和支持心脏功能方面的失败，先前的治疗方案已被推翻。然而，在这种致命情况下摒弃传统治疗方法对医护人员来说并非没有代价。引入新的治疗方法，包括拒绝使用水溶性化合物进行洗胃、使用高分子量胶体溶液进行液体复苏以及使用碳酸氢钠和血管活性药物进行终止治疗，有望提高患者的生存率。该方案正处于早期临床评估阶段；尽管如此，它似乎能提高患者的生存率；因此，未来应进行随机试验以证实其有效性。
