(Used for grain preservation)
Clinical features:
- GIT: nausea, vomiting, diarrhea, epigastric pain
- Cardiovascular: hypotension, shock (invariably), arrhythmia
- Respiratory: tachypnea, ARDS
- Hepatic: tender hepatomegaly, jaundice, elevated liver enzymes
- Renal: oliguria, AKI
- CNS: restless, coma
- Metabolic: metabolic acidosis, hypomagnesemia, hypermagnesemia, hypokalemia
Management:
- No antidote, only supportive
- Before starting treatment, medical stuff should protect themselves with full face mask and rubber gloves
- Removal of contaminated clothes
- Skin, eyes washing with tap water
- Potassium permanganate solution (1:10000) → it oxidizes phosphine gas in the stomach to phosphate
- Mixture of sodium bicarbonate solution (2%) and coconut oil (50 ml + 50 ml) → reduce acidic environment of the stomach
- Fluid resuscitation
- Correct acidosis by sodi-bi-carb
- Correct electrolytes imbalance
- Correct shock: dopamine/noradrenaline, IV steroid (hydrocortisone: 200-400 mg or dexamethasone 4 mg IV 4 hourly)
- Correct dyspnea: 100 % oxygen (hyperbaric oxygen)
- Prolonged PT: Vit K 10 mg IV daily
- Methemoglobinemia: Vit-C (1 gm 6 hourly, IV) + methylene blue (1 mg/kg, 1% solution)
- Cardiac arrhythmia: anti arrhythmic, trimetazidine
- NAC and Magsalph: no specific evidence
Outcome:
- High mortality rate: 40- 80%
- majority of death: within 12-24 hours, refractory hypotension, arrhythmia
- Death after 24 hours: ARDS, liver failure, renal failure, other complications
Precaution/Prevention:
- should be banned
- Granular/powder form, rather than tablet form
- Strong administrative control: only license holder can buy