Aluminium phosphide poisoning in children -challenges in diagnosis and management

Metal phosphides in general and aluminium phosphide in particular are potent insecticides and rodenticides. These are commercially used for protection of crops during storage, as well as during transportation. They are highly toxic substances and its poisoning is a common pediatric emergency leading to mortality and morbidity in children. Thousand of innocent children are poisoned accidentally every year throughout the world mainly due to their innovative and exploratory nature and mouthing tendency. Following the ingestion of metal phosphide, phosphine gas is generated which is rapidly absorbed throughout the gastrointestinal tract, reaches the blood stream and causes multisystemic involvement We tried to review the various aspects of toxicity associated with aluminium phosphides, including clinical presentation specially unusual presentation ,diagnostic and management challenges and poor prognostic indices. The presentation varies from GIT manifestation to shock, cardiac arrhythmias, renal failure, metabolic acidosis and rare presentation pleural effusion, ascites, pericarditis, acute respiratory distress(ARDS). Diagnosis is based on clinical suspicion, history of ingestion, clinical manifestations with garlic or decaying fish odour, unexplained shock .A range of chemical tests and analytical methods may be used for the analysis of sample like silver nitrate impregnated paper test on the gastric fluid of patients, a reliable and sensitive method to detect phosphine In management role of magnesium sulphate (MgSo4.) in reducing the cardiac arrhythmias and mortality is well documented.