Cardiovascular profile of aluminium phosphide poisoning and its clinical significance

Sudhir Kalawat, Vibhuti Thakur, Ashok Thakur, N. D. Punjabi


Background: Aluminium phosphide is a solid fumigant pesticide and it has currently aroused interest with increasing number of poisoning cases in past three decades. Over the time it has become an effective and widely used medium for suicide and homicide. Aluminium phosphide has highly effective killing power. Death is due to its direct toxic effect over the heart leading to peripheral circulatory failure .Aluminium phosphide poisoning affects the most of the organs. Early symptoms include nausea, vomiting, retrosternal and epigastric pain, dyspnea, anxious, agitation and smell of garlic breath.

Methods: 50 patients, who were admitted in MICU, following consumption of aluminium phosphide tablets were included in the study. Patient’s clinical evaluation was done as per standard. PaO2 was noted with pulse oxymeter. Troponin I, ECG and echo of the patients was done to study the cardiac toxicities and pathological reports were correlated.  

Results: Out of 50 cases, ECG was normal in 20 cases and abnormal in 30 cases-sinus tachycardia was most common finding (24%) while heart block was least (4%). On echo, hypokinesia was seen in 40% cases, decreased ejection fraction in 8% cases and normal echo was seen in 12% cases. Serum troponin test was positive in 26%. Out of 50 cases, 19 died and rest 31 cases survived.

Conclusions: AgNO3 test, ECG and pulse oxymetry are bed side, cost effective tools and should be done in all cases. Echocardiography is a useful tool to evaluate cardiac function and cardiac anatomy. Whenever it is available, it must be done in cases of aluminium phosphide poisoning. Serum troponin-I test should be done to assess significant myocardial damage. Thus, proper clinical work out along with relevant investigations and management as per standard protocol may save many more lives.


Aluminium phosphide, AgNO3 test, Cardiac toxicity, Serum troponin

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