Agrochemical and household poisons

Aluminium phosphide (celphos) poisoning

Reviewed Nov 2026·1 references
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Phosphine gas causes refractory shock from myocardial toxicity, severe metabolic acidosis and arrhythmias within hours. There is no antidote: early ICU care, gastric decontamination, magnesium, vasopressors, inotropes, bicarbonate and, where available, VA-ECMO as a bridge.

At the bedside

Timed steps
  1. 1

    Suspect

    0 min

    Grain fumigant tablets (3 g, releasing phosphine) ingestion; garlic/rotten fish odour; vomiting, shock, acidosis. Silver nitrate paper test on gastric aspirate/breath turns black.

  2. 2

    Early

    Decontaminate

    Gastric lavage with potassium permanganate (1:10,000) or coconut/paraffin oil to limit phosphine release is practised in India (evidence weak); activated charcoal; staff should avoid inhaling vomitus gases.

  3. 3

    Support

    Shock

    Echo-guided fluids (beware LV dysfunction and pulmonary oedema), noradrenaline, dobutamine/adrenaline for myocardial depression; correct acidosis with bicarbonate; early intubation.

  4. 4

    Unproven

    Adjuncts

    Magnesium sulphate, N-acetylcysteine, trimetazidine and others are used in Indian centres; none proven in large RCTs.

  5. 5

    VA-ECMO

    Rescue

    Myocardial toxicity is reversible over 48-72 h; VA-ECMO has been used successfully as a bridge where available.

Aluminium phosphide arrhythmias/hypomagnesaemia

Magnesium sulphate

IV
Dose
2-3 g over 20 min, then 1 g/h (guided by levels)
Red flag · call your senior now
SBP < 90 with pH < 7.2 within hours of ingestion: very high mortality; involve ECMO centre early if available.
Pitfall
Aggressive fluid loading in cardiogenic shock.
Pitfall
Water lavage without precautions (phosphine release).
Pearl
Arrhythmias and myocardial dysfunction typically resolve by day 3 if the patient survives.

References

  1. 1

    Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock. 2011;4(3):378-384

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