Cardiovascular manifestations of acute aluminium phosphide poisoning and their impact on survival


  • Nithyapriya T. K. KPS institute of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
  • Richa Giri KPS institute of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
  • Mohit Sachan KPS institute of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
  • Aadil Mahmood Khan KPS institute of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India



Celphos, AlP, Cardiac poison, Cardiovascular, Survival


Background: Aluminium phosphide (AlP) is a common suicidal poison with a high mortality rate due to its cardiovascular impact and lack of antidote. The aim of the study was to describe the electrocardiographic changes and other cardio-vascular manifestations in acute AlP poisoning and evaluate its impact on survival outcomes.

Methods: A prospective cross-sectional study was conducted in a tertiary care hospital including patients who presented with acute AlP ingestion in any form. Patients’ vitals and ECG at the time of admission were taken and outcomes of survival were identified. A descriptive study of echocardiography was also done. The clinical parameters were correlated with the survival outcomes.

Results: Fifty patients were included with 30 males and 20 females. The consumption of AlP in tablet form caused more hemodynamic compromise (hypotension and high anion gap metabolic acidosis) as compared to the powder form. ECG changes were seen in 42% of the cases, the most common finding was prolonged QTc interval (26%). The mortality was 30%. Hypotension, bradycardia, and QRS widening were found to be significant predictors of mortality (p<0.05). Echocardiography was performed for 10 patients, of which, one had right ventricular dysfunction and two had left ventricular dysfunction.

Conclusions: AlP tablets are more lethal and hemodynamically compromising than AlP powder. Hypotension, bradycardia, and QRS widening are significant predictors of mortality. Direct cardiotoxicity leads to ECG changes, of which, QTc prolongation is the most common.

Author Biography

Nithyapriya T. K., KPS institute of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India

Junior Resident


Karimani A, Mohammadpour AH, Zirak MR. Antidotes for aluminum phosphide poisoning-An update. Toxicol Rep. 2018;5:1053-9.

Mathai A, Bhanu MS. Acute aluminium phosphide poisoning: Can we predict mortality? Indian J Anaesth. 2010;54(4):302-307.

Arshia BS, Garima K, Simran B, Kumud B, Floor A. Aluminium phosphide: toxicity mechanism and credible treatments. 2016;19(5):291-293.

Gupta MS, Malik A, Sharma VK. Cardiovascular manifestations in aluminium phosphide poisoning with special reference to echocardiographic changes. J Assoc Physicians India. 1995;43(11):773-80.

Soltaninejad K, Beyranvand MR, Momenzadeh SA, Shadnia S. Electrocardiographic findings and cardiac manifestations in acute aluminum phosphide poisoning. J Forensic Leg Med. 2012;19(5):291-3.

Chugh SN, Dushyant, Ram S, Arora B, Malhotra KC. Incidence and outcome of aluminium phosphide poisoning in a hospital study. Indian J Med Res. 1991;94:232-5.

Singh S, Dilawari JB, Vashist R, Malhotra HS, Sharma BK. Aluminium phosphide ingestion. Br Med J (Clin Res Ed). 1985;290(6475):1110-1.

Abedini M, Fatehi F, Tabrizi N. Ischemic Stroke as a Rare Manifestation of Aluminum Phosphide Poisoning: an Case Report. Acta Med Iran. 1;52(12):947-9.

Chugh SN, Arora V, Kaur S, Sood AK. Toxicity of exposed aluminium phosphide. J Assoc Physicians India. 1993;41(9):569-70.

Elgazzar FM, Shama MA, Shoeib O, Hafez ASAF. The Role of Echocardiographic Findings in Estimating Survival Probability of Intensive Care Unit Admitted Aluminum Phosphide Poisoned Patients. J Med Toxicol. 2022;18(2):128-38.

Pannu AK, Bhalla A, Sharma A, Sharma N. "PGI Score": A Simplified Three-point Prognostic Score for Acute Aluminum Phosphide Poisoning. Indian J Crit Care Med. 2020;24(9):790-3.






Original Research Articles