Aluminium Phosphide poisoning

Aluminium Phosphide, commonly called Alphos in our region is one of the most dangerous poisons used to commit suicide. The ultimate result is almost certain death. And I hardly remember a patient who made it, until we found out about a new approach to treat such patients. But, before I describe about the new treatment which we happened to stumble upon – something about the poison.

You can read more about the poison by clicking here. I remember talking to one of my friends who used to work in the Food Corporation of India quite a long time ago during my high-school days. He was the first one who told me about this poison as well as showed me couple of tablets of aluminium phosphide. To demonstrate the potency of the poison, he showed me how one tablet was used as a insecticide for quite a large amount of foodgrains stocked up in gunny bags. Only one tablet was needed to be kept in the middle of a pile of about 100 gunny bags of food grains to keep the whole lot free of pests.

So, one can imagine how poisonous the substance was.

So, what is it that we are doing new? We’ve already had 4 patients who have gone home alive. The usual treatment comprises of maintaining blood pressure by giving dopamine drip. We also give magnesium sulphate injections. However, there are conflicting reports on how it helps.

I was having a casual talk about this with one my friends who were doing his post-graduation in one of the medical colleges nearby. It happened that his thesis happened to be about ‘Alphos’ poisoning. He told me about the part of giving coconut oil along with activated charcoal after the stomach wash. So, we started to do it on a experimental basis.

There were few papers on this in the research available in the internet. You can read about it either here, or here. It has worked wonders so far. There were 2 patients who had gone into hemodynamic failure. The other two had come quite early that they did not go into shock after we had given them stomach wash followed by coconut oil put into the stomach.

Later I found out about anecdotal reports of local healers in Africa especially Morocco who treat patients with clarified butter (ghee). I was a bit surprised that not many clinicians had heard about this although I found research papers published as early as 2005.

However, there are quite a number of factors which are known to determine survival in ‘Alphos’ poisoning which include aspects such as vomiting after poison ingestion, the number of tablets which is taken and how fresh the ingested tablets were. It seems that if the tablets are kept in the open for quite some time, they lose their potency.

I’m not sure if any other oil will work. However, it is quite funny that coconut oil which is more of a part of South Indian cuisine is found to be useful in ‘Alphos’ poisonings which is more prevalent in the north of the country. One of my patients had complained about the odd taste of the coconut oil which he could not tolerate. But, I told him that maybe it was the ‘unpalatable thing’ that saved him.