Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report
Abstract Background Aluminum phosphide (rice tablet) is a highly efficient agent for preserving grains against rodents and insects. It accounts for a large number of poisoning cases. Aluminum phosphide poisoning has a high mortality rate of about 90%, and to date, no antidote is available. It releas...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-022-03425-4 |
| _version_ | 1811248599387865088 |
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| author | Moslem Sedaghattalab |
| author_facet | Moslem Sedaghattalab |
| author_sort | Moslem Sedaghattalab |
| collection | DOAJ |
| description | Abstract Background Aluminum phosphide (rice tablet) is a highly efficient agent for preserving grains against rodents and insects. It accounts for a large number of poisoning cases. Aluminum phosphide poisoning has a high mortality rate of about 90%, and to date, no antidote is available. It releases phosphine gas after exposure to moisture, and this reaction is catalyzed by the acidity of the stomach. Phosphine is then absorbed throughout the respiratory or gastrointestinal tracts and causes toxicity through inhibition of cytochrome c oxidase and formation of highly reactive free radicals. Treatment of patients with aluminum phosphide poisoning is supportive, including mechanical ventilation and vasopressors. The usage of infusion of glucose-insulin-potassium in rice tablet poisoning has been suggested, after its positive beneficial cardiac inotropic effects in patients with beta-blocker and calcium channel blocker poisoning. Case presentation We report the case of a 30-year-old Iranian woman with critical aluminum phosphide poisoning, presented with hypotension and other signs of shock and severe metabolic acidosis, successfully treated with high-dose regular insulin and hypertonic dextrose and discharged from hospital in good condition. In contrast to our previous experiences, in which nearly all patients with critical aluminum phosphide poisoning died, this patient was saved with glucose-insulin-potassium. Conclusion Aluminum phosphide poisoning has a high mortality rate, and to date, no antidote is available. Administration of high-dose intravenous regular insulin and dextrose is suggested as a potential life-saving treatment for patients with critical aluminum phosphide poisoning. |
| first_indexed | 2024-04-12T15:31:58Z |
| format | Article |
| id | doaj.art-010e45c84ea743b3a13165503ab28452 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-12T15:31:58Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-010e45c84ea743b3a13165503ab284522022-12-22T03:27:04ZengBMCJournal of Medical Case Reports1752-19472022-05-011611310.1186/s13256-022-03425-4Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case reportMoslem Sedaghattalab0Department of Internal Medicine, Emam Sajad Hospital, Yasuj University of Medical SciencesAbstract Background Aluminum phosphide (rice tablet) is a highly efficient agent for preserving grains against rodents and insects. It accounts for a large number of poisoning cases. Aluminum phosphide poisoning has a high mortality rate of about 90%, and to date, no antidote is available. It releases phosphine gas after exposure to moisture, and this reaction is catalyzed by the acidity of the stomach. Phosphine is then absorbed throughout the respiratory or gastrointestinal tracts and causes toxicity through inhibition of cytochrome c oxidase and formation of highly reactive free radicals. Treatment of patients with aluminum phosphide poisoning is supportive, including mechanical ventilation and vasopressors. The usage of infusion of glucose-insulin-potassium in rice tablet poisoning has been suggested, after its positive beneficial cardiac inotropic effects in patients with beta-blocker and calcium channel blocker poisoning. Case presentation We report the case of a 30-year-old Iranian woman with critical aluminum phosphide poisoning, presented with hypotension and other signs of shock and severe metabolic acidosis, successfully treated with high-dose regular insulin and hypertonic dextrose and discharged from hospital in good condition. In contrast to our previous experiences, in which nearly all patients with critical aluminum phosphide poisoning died, this patient was saved with glucose-insulin-potassium. Conclusion Aluminum phosphide poisoning has a high mortality rate, and to date, no antidote is available. Administration of high-dose intravenous regular insulin and dextrose is suggested as a potential life-saving treatment for patients with critical aluminum phosphide poisoning.https://doi.org/10.1186/s13256-022-03425-4Aluminum phosphideRice tabletInsulinGIKCase report |
| spellingShingle | Moslem Sedaghattalab Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report Journal of Medical Case Reports Aluminum phosphide Rice tablet Insulin GIK Case report |
| title | Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report |
| title_full | Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report |
| title_fullStr | Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report |
| title_full_unstemmed | Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report |
| title_short | Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report |
| title_sort | treatment of critical aluminum phosphide rice tablet poisoning with high dose insulin a case report |
| topic | Aluminum phosphide Rice tablet Insulin GIK Case report |
| url | https://doi.org/10.1186/s13256-022-03425-4 |
| work_keys_str_mv | AT moslemsedaghattalab treatmentofcriticalaluminumphosphidericetabletpoisoningwithhighdoseinsulinacasereport |