Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Drug Metab Lett. 2021;14(2):106-116. doi: 10.2174/1872312814666210813115625.
Due to its easy availability, rapid and severe toxicity, and no specific antidote, aluminum phosphide has emerged as a lethal toxin, commonly used for suicidal intent in agricultural communities. Despite various advances in medicine, this compound's toxicity is poorly understood, and it still has a very high case fatality rate with no definitive treatment options available. This review aims to understand the mechanism of toxicity, clinical toxidrome of acute aluminum phosphide poisoning, and the available therapeutic options, including recent advances. A literature review was performed searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: ("aluminum phosphide poisoning" OR "aluminum phosphide poisoning toxicity" OR "aluminum phosphide ingestion") AND ("management" OR "therapy" OR "treatment"). Selected articles were discussed amongst all the authors to shape this review. High case fatality rate and lack of any specific antidote are persisting challenges. Therapeutic measures need to be implemented from all fronts - reducing easy access to the poison, developing less toxic alternatives for use as a pesticide, and more studies directed at developing an effective reversal agent for phosphine. The advent of promising agents like glucose-insulin-potassium infusion and lipid emulsion is a new ray of hope in the complete recovery in this fatal poisoning. The need of the hour is to find an agent that rapidly and effectively reverses aluminum phosphide's toxic effects. Large multicenter controlled trials are required to establish the role of glucose-insulin-potassium and lipid emulsion.
由于磷化铝易于获得、毒性剧烈且迅速，并且没有特效解毒剂，因此已成为一种致命毒素，在农业社区中常被用于自杀。尽管医学取得了各种进步，但人们对这种化合物的毒性仍知之甚少，而且由于没有明确的治疗选择，其病死率仍然非常高。本综述旨在了解毒性作用机制、急性磷化铝中毒的临床中毒表现以及现有的治疗选择，包括最新进展。通过在 PubMed、EMBASE Ovid 和 Cochrane Library 上搜索，使用以下搜索项进行文献回顾：("aluminum phosphide poisoning" OR "aluminum phosphide poisoning toxicity" OR "aluminum phosphide ingestion") AND ("management" OR "therapy" OR "treatment")。选择的文章由所有作者共同讨论，以形成本综述。高病死率和缺乏特效解毒剂仍然是持续存在的挑战。需要从各个方面采取治疗措施——减少对毒物的轻易获取，开发毒性较小的替代品用于农药，以及更多研究致力于开发有效的磷化氢逆转剂。葡萄糖-胰岛素-钾输注和脂肪乳剂等有前途的药物的出现为这种致命中毒的完全康复带来了新的希望。当务之急是找到一种能够快速有效地逆转磷化铝毒性作用的药物。需要进行大型多中心对照试验来确定葡萄糖-胰岛素-钾和脂肪乳剂的作用。
