The most common pesticide agents are organophosphates and phosphides, aluminum phosphide (ALP) in particular. ALP is a major cause of suicidal poisoning in many countries. In other countries, the problem of accidental, mainly occupational-related, poisoning is also real and actual. Almost two thirds of individuals in poisoning cases have died. This case report describes a case of a patient with accidental ALP intoxication. The origin of the poisoning was the fumigation of stored grain in an agricultural building adjacent to the building in which patient was temporarily housed, while both buildings were connected by an underground corridor, through which the released poison gas penetrated. The case was originally presented by the rescuers as well as healthcare professionals of the local hospital as carbon monoxide intoxication, which has a similar symptomatology as ALP intoxication. The patient was treated comprehensively, including using the HBOT method, which is very unique in the case of phosphine intoxication in human medicine, with an excellent final clinical outcome. This was the first described case of HBOT for ALP intoxication in clinical medicine, although the HBOT indication itself became a coincidence in this case. Further studies must be undertaken to demonstrate the effectiveness of HBOT in treating patients with ALP poisoning.

Centre for Hyperbaric Medicine of Faculty of Medicine University of Ostrava and Ostrava City Hospital 70300 Ostrava Czech Republic

Centre of Hyperbaric Medicine Ostrava City Hospital 72880 Ostrava Czech Republic

Department of Forensic Medicine and Medical Law University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc 77900 Olomouc Czech Republic

Department of Forensic Medicine and Medicolegal Expertises Jessenius Faculty of Medicine Comenius University University Hospital 036 01 Martin Slovakia

Faculty of Biomedical Engineering Czech Technical University Prague 16000 Prague Czech Republic

Institute of Laboratory Medicine Institute of Microbiology Faculty of Medicine University of Ostrava 70300 Ostrava Czech Republic

The Institute of Aviation Medicine 16000 Prague Czech Republic

Zobrazit více v PubMed

Mehrpour O., Jafarzadeh M., Abdollahi M. A systematic review of aluminium phosphide poisoning. Arh. Hig. Rada Toksikol. 2012;63:61–73. doi: 10.2478/10004-1254-63-2012-2182. PubMed DOI

Singh D., Dewan I., Pandey A.N., Tyagi S. Spectrum of unnatural fatalities in the Chandigarh zone of north-west India—A 25 year autopsy study from a tertiary care hospital. J. Clin. Forensic Med. 2003;10:145–152. doi: 10.1016/S1353-1131(03)00073-7. PubMed DOI

Gupta S., Ahlawat S.K. Aluminum phosphide poisoning—A review. J. Toxicol. Clin. Toxicol. 1995;33:19–24. doi: 10.3109/15563659509020211. PubMed DOI

Shumet A., Shiferaw N., Mekonnen D., Asemahagn M.A. Trends and Outcomes of Acute Poisoning in Felege Hiwot Comprehensive Specialized Hospital Medical Intensive Care Units: Retrospective Study. Open Access Emerg. Med. 2022;14:649–656. doi: 10.2147/OAEM.S385420. Erratum in Open Access Emerg. Med. 2023, 15, 13–14. PubMed DOI PMC

Van de Sijpe P., Canals M.L., Jensen O., Lucas D. Acute occupational phosphine intoxications in the maritime shipping sector: A scoping review. Arch. Environ. Occup. Health. 2022;77:636–652. doi: 10.1080/19338244.2021.1990829. PubMed DOI

Hinz R., Mannetje A., Glass B., McLean D., Douwes J. Neuropsychological symptoms in workers handling cargo from shipping containers and export logs. Int. Arch. Occup. Environ. Health. 2022;95:1661–1677. doi: 10.1007/s00420-022-01870-8. PubMed DOI PMC

Djurhuus R. Fumigation on bulk cargo ships: A chemical threat to seafarers. Int. Marit. Health. 2021;72:206–216. doi: 10.5603/IMH.2021.0039. PubMed DOI

Moghadamnia A.A. An update on toxicology of aluminum phosphide. DARU J. Pharm. Sci. 2012;20:25. doi: 10.1186/2008-2231-20-25. PubMed DOI PMC

Mehrpour O., Alfred S., Shadnia S., Keyler D.E., Soltaninejad K., Chalaki N., Sedaghat M. Hyperglycemia in acute aluminum phosphide poisoning as a potential prognostic factor. Hum. Exp. Toxicol. 2008;27:591–595. doi: 10.1177/0960327108096382. PubMed DOI

Agrawal V.K., Bansal A., Singh R.K., Kumawat B.L., Mahajan P. Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote. Indian. J. Crit. Care Med. 2015;19:109–112. doi: 10.4103/0972-5229.151019. PubMed DOI PMC

Shafahi A., Mostafazadeh B., Dadpour B. Inhalational Toxicity of Aluminum Phosphide as an Ongoing Concern; a Report of Two Cases. Arch. Acad. Emerg. Med. 2019;7:e69. PubMed PMC

Lemoine T.J., Schoolman K., Jackman G., Vernon D.D. Unintentional fatal phosphine gas poisoning of a family. Pediatr. Emerg. Care. 2011;27:869–871. doi: 10.1097/PEC.0b013e3182348e40. PubMed DOI

Hsu C.H., Chi B.C., Liu M.Y., Li J.H., Chen C.J., Chen R.Y. Phosphine-induced oxidative damage in rats: Role of glutathione. Toxicology. 2002;179:1–8. doi: 10.1016/S0300-483X(02)00246-9. PubMed DOI

Chugh S.N., Kolley T., Kakkar R., Chugh K., Sharma A. A critical evaluation of anti-peroxidant effect of intravenous magnesium in acute aluminium phosphide poisoning. Magnes. Res. 1997;10:225–230. PubMed

Marashi S.M., Arefi M., Behnoush B., Nasrabad M.G., Nasrabadi Z.N. Could hydroxyethyl starch be a therapeutic option in management of acute aluminum phosphide toxicity? Med Hypotheses. 2011;76:596–598. doi: 10.1016/j.mehy.2011.01.009. PubMed DOI

Oghabian Z., Mehrpour O. Treatment of Aluminium Phosphide Poisoning with a Combination of Intravenous Glucagon, Digoxin and Antioxidant Agents. Sultan Qaboos Univ. Med. J. 2016;16:e352–e355. doi: 10.18295/squmj.2016.16.03.015. PubMed DOI PMC

Saidi H., Shokraneh F., Ghafouri H.B., Shojaie S. Effects of hyperbaric oxygenation on survival time of aluminum phosphide intoxicated rats. J. Res. Med. Sci. 2011;16:1306–1312. PubMed PMC

Mathieu D., Marroni A., Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: Recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb. Med. 2017;47:24–32. doi: 10.28920/dhm47.2.131-132. Erratum in Diving Hyperb. Med. 2017, 47, 131–132. PubMed DOI PMC

Chmelař D., Rozložník M., Hájek M., Pospíšilová N., Kuzma J. Effect of hyperbaric oxygen on the growth and susceptibility of facultatively anaerobic bacteria and bacteria with oxidative metabolism to selected antibiotics. Folia Microbiol. 2023. ahead of print . PubMed DOI PMC

Gagnier J.J., Kienle G., Altman D.G., Moher D., Sox H., Riley D., CARE Group The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob. Adv. Health Med. 2013;2:38–43. doi: 10.7453/gahmj.2013.008. PubMed DOI PMC

Material Safety Data Sheet. [(accessed on 15 March 2023)]. Available online: https://www.siad.com/en/safety/material-safety-data-sheet.

Jaiswal S., Verma R.K., Tewari N. Aluminum phosphide poisoning: Effect of correction of severe metabolic acidosis on patient outcome. Indian. J. Crit. Care Med. 2009;13:21–24. doi: 10.4103/0972-5229.53111. PubMed DOI PMC

Karimani A., Mohammadpour A.H., Zirak M.R., Rezaee R., Megarbane B., Tsatsakis A., Karimi G. Antidotes for aluminum phosphide poisoning—An update. Toxicol. Rep. 2018;5:1053–1059. doi: 10.1016/j.toxrep.2018.10.009. PubMed DOI PMC

Savateev N.V., Tonkopiĭ V.D., Brestkina L.M., Gromov A.E. An analysis of the mechanism of the therapeutic effect of oxygen under pressure in poisoning with phosphoorganic compounds. Biull Eksp. Biol. Med. 1973;75:51–53. doi: 10.1007/BF00805004. (In Russian) PubMed DOI