Gastric ventilation: a new approach to metal phosphide fumigant ingestion

Phosphine is absorbed rapidly across mucous membranes causing systemic poisoning including functional cellular hypoxia. Following ingestion of metal phosphides, continuous absorption of phosphine could contribute to the intractable systemic manifestations.

A 16-year-old male was admitted to hospital 1-hour post-ingestion of two fresh 3 g tablets of aluminum phosphide 56%. He complained of abdominal discomfort and burning pain, thirst, nausea, and foul-odor vomitus. The silver nitrate test was positive by exhaled breath and gastric content, confirming exposure to phosphine. Initial therapy included intravenous fluids and gastric lavage with sodium bicarbonate and potassium permanganate. Hypotension, severe agitation and tachypnea prompted endotracheal intubation and treatment with gastric ventilation. This procedure involves insertion of a nasogastric tube to insufflate air into the distal part of the stomach. An orogastric tube is inserted near the gastro-esophageal junction as an inflow air tract. Ventilation was provided by blowing fresh air using an air-pump into the naso-gastric tube and phosphine contaminated air escaped via the wide-bore orogastric tube; the treatment continued for several hours. Although there was some evidence of progression of poisoning, including metabolic acidosis, arterial fibrillation, and mild gastrointestinal bleeding, the patient subsequently recovered and was discharged 6 days later with no persisting complications. This case report discusses probable benefit, availability, and simplicity of this treatment. We suggest that further clinical trials are required to confirm that this treatment improves outcomes in this highly toxic poisoning.