87p. 87-94
MANAGEMENT OF ALUMINUM
PHOSPHIDE POISONINGVol. 16 Número 2 2025
Título español
MANAGEMENT OF ALUMINUM PHOSPHIDE POISONING
RESUMEN
ABSTRACT
(1) Carrera de Medicina, Facultad de Salud Pública, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador.
Autor de correspondencia:
Correo electrónico: igor.astudillo@espoch.edu.ec
Introducción: El fosfuro de aluminio es un plaguicida utilizado para controlar las plagas de los cereales almacenados. Es altamente tóxico
y representa un gran riesgo para el ser humano si se ingiere o inhala. Las intoxicaciones por fosfuro de aluminio, tanto accidentales
como intencionadas, son frecuentes y difíciles de tratar. Esta revisión analiza sus efectos en la salud humana, así como las opciones
de tratamiento y prevención. Objetivo: Describir los efectos tóxicos del fosfuro de aluminio y sus implicaciones para la salud pública,
el tratamiento y la prevención. Metodología: Se realizó una revisión bibliográfica narrativa que incluyó 36 estudios entre revisiones,
reportes de caso y análisis clínicos. Se incorporaron trabajos que describieran el mecanismo tóxico, manifestaciones clínicas o enfoques
terapéuticos, y se excluyeron artículos sin relevancia o con información insuficiente. Resultados: La evidencia muestra que la exposición
a fosfuro de aluminio conlleva a la liberación de fosfina, la cual interfiere con la fosforilación oxidativa e induce estrés oxidativo en la
mitocondria, causando muerte celular y deterioro progresivo de órganos vitales. Los síntomas más reportados fueron náuseas, vómitos,
dolor abdominal, insuficiencia respiratoria y compromiso cardiovascular. No existe un antídoto específico, por lo que el manejo se basa en
soporte intensivo. Discusión: La tasa de mortalidad es alta debido a la rápida acción del compuesto tóxico y a la falta de un tratamiento
específico. Conclusiones: La intoxicación por fosfuro de aluminio es una emergencia médica que requiere una intervención inmediata.
Deben mejorarse las políticas de control y prevención y aumentar la concienciación pública para reducir los casos de intoxicación.
Palabras claves: intoxicación, fosfuro de aluminio, manejo, prevención, tratamiento.
Introduction: Aluminium phosphide is a pesticide used to control pests in stored grains. It is highly toxic and poses a great risk to humans
if ingested or inhaled. Both accidental and intentional aluminium phosphide poisonings are frequent and difficult to treat. This review
discusses its effects on human health, as well as treatment and prevention options. Objective: To describe the toxic effects of aluminium
phosphide and its consequences for public health, treatment, and prevention. Methodology: We conducted a narrative review of 30
studies that included reviews, case reports, and clinical analyses, describing the toxic mechanism, clinical manifestations, or therapeutic
approaches, and excluded irrelevant or insufficiently informative articles. Results: The evidence shows that the exposure to aluminium
phosphide leads to phosphine release, which interferes with oxidative phosphorylation and induces oxidative stress, causing cell death and
progressive destruction of vital organs. The most frequently reported symptoms were nausea, vomiting, abdominal pain, and respiratory
and cardiac failure. Treatment is supportive since there is no specific antidote. Discussion: The mortality rate is high due to the rapid
action of the toxic compound and the lack of specific treatment. Conclusions: Aluminum phosphide poisoning is a medical emergency
that requires immediate intervention. The control and prevention policies should be improved and public awareness increased in order
to cut down cases of poisoning.
Keywords: Intoxication, aluminum phosphide, management, prevention, treatment.
ARTÍCULO DE REVISIÓN Historial del artículo: Recibido: 02/06/2025 · Aceptado: 20/01/2026 · Publicado: 25/01/2026
https://cssn.espoch.edu.ec
iD iD iDCedeño Sarabia Leidy Aracely ⁽¹⁾ Chimbo Chimbo Mayra Nataly ⁽¹⁾ Igor Eduardo Astudillo Skliarova ⁽¹⁾*
leidy.cedenio@espoch.edu.ec nataly.chimbo@espoch.edu.ec igor.astudillo@espoch.edu.ec
DOI: https://doi.org/10.47187/cssn.Vol16.Iss2.446
88Cedeño Sarabia Leidy Aracely, et al.Vol. 16 Número 2 2025
Pesticide poisoning is a serious public health
problem worldwide and affects over 3 million
people every year. It is estimated that around
200,000 people die each year due to pesticide
poisoning1,2. This situation is of great concern,
particularly in developing countries, where death
rates and contamination by pesticides exceed
those of infectious diseases2 . Aluminum phosphide
poisoning has also been reported in Ecuador. A
retrospective review shows that between 2001 and
2007, 14,145 cases of poisoning were reported3.
Pesticides are very effective for combating invasive
insects at any stage of development, leave a low
concentration of residues in treated foods and
not affect the viability of seeds. However, various
pesticides, including aluminum phosphide, are
highly toxic2 .
Upon contact with moisture, aluminum phosphide
releases a lethal gas known as phosphine or
phosphine gas, which is colorless but exhibits a
characteristic odor that resembles "decomposed
fish" or "concentrated garlic". Exposure to this
gas may result in poisoning and can be especially
dangerous, as gastric moisture accelerates the
release of this gas, causing shock, myocarditis,
lethal arrhythmias and multiple organ failure3.
Even a small amount of this poison can have
devastating effects, since approximately 1 mg/kg
of an individual's weight is enough to cause death,
which means that a small portion of a tablet can be
enough to kill a 70 kg person4. It is concerning that
aluminum phosphide is used in rural areas in cases
of suicide attempts, due to its easy accessibility,
low cost and high lethality, causing death in a short
period of time5 .
Patients with risk factors for suicide, especially
in vulnerable populations such as children,
adolescents and young adults, are the most
affected 6 . There are reports indicating that female
patients are at higher risk of suicide. This often
occurs due to family disintegration or early union
dissolution, which can lead to depression or
suicidal behaviors7
.
The mortality associated with aluminum
phosphide poisoning can be as high as 80%. Typical
features of the patient include clammy, cold skin,
weak thready pulse, and severe hypotension
often refractory to vasopressors. If the patient
survives the initial shock, acute renal failure may
supervene. Mentally, the patients remain lucid but
A non-systematic and narrative literature research
focused on the management of aluminum
phosphide poisoning was conducted, using
Boolean operators such as "AND", "OR" and "NOT"
together with specific keywords such as "aluminum
phosphide", "acute poisoning", "treatment" and
“physiopathological mechanism”. The main
platform used for the search was Google Scholar,
complemented by medical journals and scientific
databases such as Medscape, SciELO, Redalyc,
Medline Plus and PubMed, among others. The
information collected was exhaustively analyzed,
selecting only the most relevant, updated and
reliable data related to the mechanisms of toxicity,
clinical manifestations and treatment of this
intoxication. Scientific articles published in the
last twenty years were included, applying a three-
stage filter: initial review of articles according
to thematic relevance, reading to verify useful
content and final approval of those that met the
established criteria. Articles outside the specified
time range or containing irrelevant data were
excluded, but articles published in English language
were included because of their relevance and
up-to-date information.
1. Introduction
2. Methodology
Following a comprehensive analysis of various
articles, the main characteristics of aluminum
phosphide poisoning, including its toxicity and
management, were identified. It is essential to
underscore that aluminum phosphide poisoning is
one of the most serious medical emergencies with
a mortality rate ranging between 40% and 80%
depending on the time elapsed since the exposure
and access to medical care, it occurs more
frequently in rural areas. It is important to know
the mechanism of toxic action since it is due to the
release of phosphine gas in contact with moisture
3. Results
restless until the shock produces cerebral anoxia,
manifesting as drowsiness, delirium and coma8,9,10 .
The objective of the present review is to describe
the toxic effects of aluminum phosphide and its
clinical, therapeutic, and public health implications.
Additionally, this review aims to synthesize
recent evidence on its toxic mechanisms, clinical
manifestations, and management strategies
implemented in different countries, providing an
up-to-date and comparative perspective on this
health issue.
Pesticide poisoning is a serious public health
problem worldwide and affects over 3 million
people every year. It is estimated that around
200,000 people die each year due to pesticide
poisoning1,2. This situation is of great concern,
particularly in developing countries, where death
rates and contamination by pesticides exceed
those of infectious diseases2 . Aluminum phosphide
poisoning has also been reported in Ecuador. A
retrospective review shows that between 2001 and
2007, 14,145 cases of poisoning were reported3.
Pesticides are very effective for combating invasive
insects at any stage of development, leave a low
concentration of residues in treated foods and
not affect the viability of seeds. However, various
pesticides, including aluminum phosphide, are
highly toxic2 .
Upon contact with moisture, aluminum phosphide
releases a lethal gas known as phosphine or
phosphine gas, which is colorless but exhibits a
characteristic odor that resembles "decomposed
fish" or "concentrated garlic". Exposure to this
gas may result in poisoning and can be especially
dangerous, as gastric moisture accelerates the
release of this gas, causing shock, myocarditis,
lethal arrhythmias and multiple organ failure3.
Even a small amount of this poison can have
devastating effects, since approximately 1 mg/kg
of an individual's weight is enough to cause death,
which means that a small portion of a tablet can be
enough to kill a 70 kg person4. It is concerning that
aluminum phosphide is used in rural areas in cases
of suicide attempts, due to its easy accessibility,
low cost and high lethality, causing death in a short
period of time5 .
Patients with risk factors for suicide, especially
in vulnerable populations such as children,
adolescents and young adults, are the most
affected 6 . There are reports indicating that female
patients are at higher risk of suicide. This often
occurs due to family disintegration or early union
dissolution, which can lead to depression or
suicidal behaviors7
.
The mortality associated with aluminum
phosphide poisoning can be as high as 80%. Typical
features of the patient include clammy, cold skin,
weak thready pulse, and severe hypotension
often refractory to vasopressors. If the patient
survives the initial shock, acute renal failure may
supervene. Mentally, the patients remain lucid but
A non-systematic and narrative literature research
focused on the management of aluminum
phosphide poisoning was conducted, using
Boolean operators such as "AND", "OR" and "NOT"
together with specific keywords such as "aluminum
phosphide", "acute poisoning", "treatment" and
“physiopathological mechanism”. The main
platform used for the search was Google Scholar,
complemented by medical journals and scientific
databases such as Medscape, SciELO, Redalyc,
Medline Plus and PubMed, among others. The
information collected was exhaustively analyzed,
selecting only the most relevant, updated and
reliable data related to the mechanisms of toxicity,
clinical manifestations and treatment of this
intoxication. Scientific articles published in the
last twenty years were included, applying a three-
stage filter: initial review of articles according
to thematic relevance, reading to verify useful
content and final approval of those that met the
established criteria. Articles outside the specified
time range or containing irrelevant data were
excluded, but articles published in English language
were included because of their relevance and
up-to-date information.
1. Introduction
2. Methodology
Following a comprehensive analysis of various
articles, the main characteristics of aluminum
phosphide poisoning, including its toxicity and
management, were identified. It is essential to
underscore that aluminum phosphide poisoning is
one of the most serious medical emergencies with
a mortality rate ranging between 40% and 80%
depending on the time elapsed since the exposure
and access to medical care, it occurs more
frequently in rural areas. It is important to know
the mechanism of toxic action since it is due to the
release of phosphine gas in contact with moisture
3. Results
restless until the shock produces cerebral anoxia,
manifesting as drowsiness, delirium and coma8,9,10 .
The objective of the present review is to describe
the toxic effects of aluminum phosphide and its
clinical, therapeutic, and public health implications.
Additionally, this review aims to synthesize
recent evidence on its toxic mechanisms, clinical
manifestations, and management strategies
implemented in different countries, providing an
up-to-date and comparative perspective on this
health issue.
89p. 87-94
MANAGEMENT OF ALUMINUM
PHOSPHIDE POISONINGVol. 16 Número 2 2025
which generates severe multisystemic damage
mainly in the cardiovascular, respiratory and
renal systems; those patients may present diverse
symptoms that most of them are non-specific
among which are included the deterioration of
the state of consciousness, multiorgan failure and
even death.
The treatment of this type of intoxication lacks a
specific antidote, so it is mainly based on providing
supportive care including decontamination,
administration of intravenous fluids,
complementary therapies in which magnesium
sulfate can be used as the main antioxidant and
antiarrhythmic.
Finally, aluminum phosphide poisoning represents
a very significant challenge due to its severity.
Current strategies are based on supportive
management but reflect a high mortality rate, so
there is a need to develop specific antidotes to
improve interventions.
Aluminum phosphide poisoning is a serious
medical condition that occurs due to the ingestion,
inhalation or contact with highly toxic chemical
compounds. Aluminum phosphide is a common
pesticide used for the storage of grains or other
agricultural products.
Symptoms of aluminum phosphide poisoning
may vary depending on the route of exposure,
but generally include gastrointestinal symptoms
(nausea, vomiting, abdominal pain, diarrhea,
burning in the mouth and throat), respiratory
symptoms (shortness of breath, chest tightness,
cough, choking sensation), cardiovascular
symptoms (tachycardia or rapid heart rate
and hypotension or low blood pressure) and
neurological symptoms (dizziness, weakness,
confusion, convulsions and coma). Therefore,
aluminum phosphide poisoning requires immediate
treatment. Treatment for aluminum phosphide
poisoning may involve different approaches
including stomach pumping, activated charcoal
or respiratory support. Additionally, treatment
should be provided for other complications based
on symptoms. Considering its toxicity, aluminum
phosphide should only be handled by trained
professionals who can take all the necessary
measures to avoid exposure. Handling changes
depend on each country and guide used11 .
4. Discussion
1.1. Management of aluminum phosphide
poisoning in El Salvador
In El Salvador, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system, regulated by the Ministry of Health,
in which it states:12
At the first level, vital function support must be
maintained with intravenous fluids and oxygen to
maintain a saturation greater than or equal to 94%
according to availability. On the other hand, check
the airway and make sure it is clear and remove
any foreign body or remains of vomit or secretions,
start invasive mechanical ventilation according to
availability, prevent aspiration in case the patient
vomits. The patient should be transferred to the
second or third level of care and gastric lavage
should not be performed if the airways are not
protected.
In the second and third levels of care, we proceed
as follows: everything described in the first level
of care, as well as continuous monitoring of vital
signs, maintaining the support of vital functions,
with intravenous fluids with a target SBP of 90
mmHg13.
A central venous catheter will be placed and
dopamine or norepinephrine will be started
even in the absence of hypotension, since the
mechanism of action of shock is imminent, in
order to decontaminate the patient and decrease
respiratory absorption and increase respiratory
elimination, assisted mechanical ventilation with
a respiratory frequency of at least 20 per minute
with PEEP of 3 to 5 should be started14 .
In case of not having a mechanical ventilator
and using a bag-mask, the personnel providing
ventilation should wear a mask to avoid inhalation
of the toxic substance. Once the airways are
protected, gastric lavage is performed and then
activated charcoal (single dose) will be started
at a dose of 1 g/kg in adults and children with
a maximum dose of 50 grams per dose and 20%
mannitol 15 to 20 ml orally, every 6 hours until
catharsis is provoked. Diuresis will be maintained
at 0.5 to 1 ml/kg/hour15 .
Magnesium sulfate is used as an anti-peroxidant
agent and as a free radical scavenger, it has also
been described to reduce cardiac arrhythmias by
50% and mortality. The loading dose of 1 gram
in 200 ml of 5% dextrose serum is taken in 30
minutes. The first day maintenance dose: 6 grams
MANAGEMENT OF ALUMINUM
PHOSPHIDE POISONINGVol. 16 Número 2 2025
which generates severe multisystemic damage
mainly in the cardiovascular, respiratory and
renal systems; those patients may present diverse
symptoms that most of them are non-specific
among which are included the deterioration of
the state of consciousness, multiorgan failure and
even death.
The treatment of this type of intoxication lacks a
specific antidote, so it is mainly based on providing
supportive care including decontamination,
administration of intravenous fluids,
complementary therapies in which magnesium
sulfate can be used as the main antioxidant and
antiarrhythmic.
Finally, aluminum phosphide poisoning represents
a very significant challenge due to its severity.
Current strategies are based on supportive
management but reflect a high mortality rate, so
there is a need to develop specific antidotes to
improve interventions.
Aluminum phosphide poisoning is a serious
medical condition that occurs due to the ingestion,
inhalation or contact with highly toxic chemical
compounds. Aluminum phosphide is a common
pesticide used for the storage of grains or other
agricultural products.
Symptoms of aluminum phosphide poisoning
may vary depending on the route of exposure,
but generally include gastrointestinal symptoms
(nausea, vomiting, abdominal pain, diarrhea,
burning in the mouth and throat), respiratory
symptoms (shortness of breath, chest tightness,
cough, choking sensation), cardiovascular
symptoms (tachycardia or rapid heart rate
and hypotension or low blood pressure) and
neurological symptoms (dizziness, weakness,
confusion, convulsions and coma). Therefore,
aluminum phosphide poisoning requires immediate
treatment. Treatment for aluminum phosphide
poisoning may involve different approaches
including stomach pumping, activated charcoal
or respiratory support. Additionally, treatment
should be provided for other complications based
on symptoms. Considering its toxicity, aluminum
phosphide should only be handled by trained
professionals who can take all the necessary
measures to avoid exposure. Handling changes
depend on each country and guide used11 .
4. Discussion
1.1. Management of aluminum phosphide
poisoning in El Salvador
In El Salvador, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system, regulated by the Ministry of Health,
in which it states:12
At the first level, vital function support must be
maintained with intravenous fluids and oxygen to
maintain a saturation greater than or equal to 94%
according to availability. On the other hand, check
the airway and make sure it is clear and remove
any foreign body or remains of vomit or secretions,
start invasive mechanical ventilation according to
availability, prevent aspiration in case the patient
vomits. The patient should be transferred to the
second or third level of care and gastric lavage
should not be performed if the airways are not
protected.
In the second and third levels of care, we proceed
as follows: everything described in the first level
of care, as well as continuous monitoring of vital
signs, maintaining the support of vital functions,
with intravenous fluids with a target SBP of 90
mmHg13.
A central venous catheter will be placed and
dopamine or norepinephrine will be started
even in the absence of hypotension, since the
mechanism of action of shock is imminent, in
order to decontaminate the patient and decrease
respiratory absorption and increase respiratory
elimination, assisted mechanical ventilation with
a respiratory frequency of at least 20 per minute
with PEEP of 3 to 5 should be started14 .
In case of not having a mechanical ventilator
and using a bag-mask, the personnel providing
ventilation should wear a mask to avoid inhalation
of the toxic substance. Once the airways are
protected, gastric lavage is performed and then
activated charcoal (single dose) will be started
at a dose of 1 g/kg in adults and children with
a maximum dose of 50 grams per dose and 20%
mannitol 15 to 20 ml orally, every 6 hours until
catharsis is provoked. Diuresis will be maintained
at 0.5 to 1 ml/kg/hour15 .
Magnesium sulfate is used as an anti-peroxidant
agent and as a free radical scavenger, it has also
been described to reduce cardiac arrhythmias by
50% and mortality. The loading dose of 1 gram
in 200 ml of 5% dextrose serum is taken in 30
minutes. The first day maintenance dose: 6 grams
90Cedeño Sarabia Leidy Aracely, et al.Vol. 16 Número 2 2025
in 250 ml of 5% dextrose serum to be administered
in 24 hours. The second maintenance day dose is
4 grams in 250 ml of 5% dextrose serum and is
given after 24 hours to 48 hours. N-acetylcysteine,
at a dose of 25 mg/kg is given every 6 hours by
nasogastric tube or intravenously for five days.
This reduces endothelial injury by free radicals. It
has also been reported to decrease the duration
of hospitalization, mechanical ventilation and
mortality16.
1.2. Management of aluminum phosphide
poisoning in Costa Rica
In Costa Rica, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system by the Ministry of Health, in which
it mentions:
Supportive measures are usually all that can be
offered, fluid therapy, vasopressors, early gastric
lavage with potassium permanganate, sodium
bicarbonate and coconut oil have also been
recommended in some literatures, and charcoal
administration and sorbitol suspension have been
described as helping to reduce absorption17
.
Despite advances in intensive care and
management to eliminate the symptoms of
aluminum phosphide poisoning, consumption of
this chemical still results in high mortality, which
would make a new method of management
extremely valuable18 . Unfortunately, there is no
known specific antidote, so management is mainly
based on supportive care19
.
1.3. Management of aluminum phosphide
poisoning in Honduras
In Honduras, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system by the Ministry of Health, which
include:
• Support of vital functions (ABC),
decontamination, antidote, and maintaining
stable vital signs and treating complications
as they arise.
• Management carried out in an intensive
care unit with immediate endotracheal
intubation accompanied by mechanical
ventilation to prevent further absorption of
the toxicant and thus increase its elimination.
It is recommended a respiratory rate of more
than 20 per minute, with high PEEP20 .
From the beginning, vital signs and blood pressure
should be monitored every 5 to 10 minutes,
then the restitution of intravenous fluids should
be started to keep the patient hydrated. If the
patient is in shock, expander solutions such as
Hartmann's or Ringer's solution should be used.
Then vasopressors such as dopamine should be
started in order to prevent phosphine from taking
up the dopamine receptors. The initial dose of
dopamine should be 5 to 10 mcg/kg/min, which
can be gradually increased up to 20-50 mcg/kg/
min if the clinical situation so indicates until blood
pressure control is achieved. The use of hydrogen
pump inhibitor is also recommended to reduce
acidosis21 .
Decontamination is performed by placing the
patient in a well ventilated place since the
elimination of aluminum phosphide occurs
through airways; in addition, gastric protection
must be provided by means of a nasogastric tube
to avoid aspiration of vomit; once the airway and
gastric tract have been protected, gastric lavage
with saline solution and activated charcoal using
a similar approach as in El Salvador22 .
Then, any complications should be treated, among
the most common are ventricular fibrillation,
ventricular extrasystoles, sinus tachycardia, sinus
bradycardia and atrioventricular block, acute
pulmonary edema, renal failure and convulsions23.
1.4. Management of aluminum phosphide
poisoning in Mexico
In Mexico, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system by the Ministry of Health, which
include:
• In medical management, the main focus
is on fluid restitution and management of
the shock state. This is done through the
generous administration of saline solution
of 2 to 3 liters in the first 8 to 12 hours,
adjusted according to the measurement of
central venous pressure. It is recommended
to maintain central venous pressure in the
range of 12 to 14 cm of water. Some authors
suggest a rapid infusion of 3 to 6 liters of
saline in 3 hours24 .
• The use of low doses of dopamine (4-6 mg/kg/
min) is recommended to maintain a systolic
pressure greater than 90 mmHg, good renal
perfusion and adequate hydration status.
in 250 ml of 5% dextrose serum to be administered
in 24 hours. The second maintenance day dose is
4 grams in 250 ml of 5% dextrose serum and is
given after 24 hours to 48 hours. N-acetylcysteine,
at a dose of 25 mg/kg is given every 6 hours by
nasogastric tube or intravenously for five days.
This reduces endothelial injury by free radicals. It
has also been reported to decrease the duration
of hospitalization, mechanical ventilation and
mortality16.
1.2. Management of aluminum phosphide
poisoning in Costa Rica
In Costa Rica, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system by the Ministry of Health, in which
it mentions:
Supportive measures are usually all that can be
offered, fluid therapy, vasopressors, early gastric
lavage with potassium permanganate, sodium
bicarbonate and coconut oil have also been
recommended in some literatures, and charcoal
administration and sorbitol suspension have been
described as helping to reduce absorption17
.
Despite advances in intensive care and
management to eliminate the symptoms of
aluminum phosphide poisoning, consumption of
this chemical still results in high mortality, which
would make a new method of management
extremely valuable18 . Unfortunately, there is no
known specific antidote, so management is mainly
based on supportive care19
.
1.3. Management of aluminum phosphide
poisoning in Honduras
In Honduras, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system by the Ministry of Health, which
include:
• Support of vital functions (ABC),
decontamination, antidote, and maintaining
stable vital signs and treating complications
as they arise.
• Management carried out in an intensive
care unit with immediate endotracheal
intubation accompanied by mechanical
ventilation to prevent further absorption of
the toxicant and thus increase its elimination.
It is recommended a respiratory rate of more
than 20 per minute, with high PEEP20 .
From the beginning, vital signs and blood pressure
should be monitored every 5 to 10 minutes,
then the restitution of intravenous fluids should
be started to keep the patient hydrated. If the
patient is in shock, expander solutions such as
Hartmann's or Ringer's solution should be used.
Then vasopressors such as dopamine should be
started in order to prevent phosphine from taking
up the dopamine receptors. The initial dose of
dopamine should be 5 to 10 mcg/kg/min, which
can be gradually increased up to 20-50 mcg/kg/
min if the clinical situation so indicates until blood
pressure control is achieved. The use of hydrogen
pump inhibitor is also recommended to reduce
acidosis21 .
Decontamination is performed by placing the
patient in a well ventilated place since the
elimination of aluminum phosphide occurs
through airways; in addition, gastric protection
must be provided by means of a nasogastric tube
to avoid aspiration of vomit; once the airway and
gastric tract have been protected, gastric lavage
with saline solution and activated charcoal using
a similar approach as in El Salvador22 .
Then, any complications should be treated, among
the most common are ventricular fibrillation,
ventricular extrasystoles, sinus tachycardia, sinus
bradycardia and atrioventricular block, acute
pulmonary edema, renal failure and convulsions23.
1.4. Management of aluminum phosphide
poisoning in Mexico
In Mexico, the management of aluminum
intoxication follows the guidelines and
recommendations established by the country's
health system by the Ministry of Health, which
include:
• In medical management, the main focus
is on fluid restitution and management of
the shock state. This is done through the
generous administration of saline solution
of 2 to 3 liters in the first 8 to 12 hours,
adjusted according to the measurement of
central venous pressure. It is recommended
to maintain central venous pressure in the
range of 12 to 14 cm of water. Some authors
suggest a rapid infusion of 3 to 6 liters of
saline in 3 hours24 .
• The use of low doses of dopamine (4-6 mg/kg/
min) is recommended to maintain a systolic
pressure greater than 90 mmHg, good renal
perfusion and adequate hydration status.
91p. 87-94
MANAGEMENT OF ALUMINUM
PHOSPHIDE POISONINGVol. 16 Número 2 2025
Hydrocortisone (200-400 mg every 4-6 hours)
is also recommended to combat shock and
reduce the dopamine dose. Epinephrine may
also be an appropriate option. It is important
to maintain a well-ventilated room, as the gas
phosphine released by aluminum phosphide
poisoning is highly toxic in enclosed spaces25
As for gastrointestinal treatment, gastric lavage
as in Costa Rica. Activated charcoal with a dose
similar to El Salvador and cathartics (such as liquid
kerosene) can then be administered to accelerate
phosphate excretion. The use of vegetable oils and
proton pump inhibitors may also be beneficial26.
In cases of metabolic acidosis, sodium bicarbonate
can be used to raise serum bicarbonate levels and
correct the acidosis. In severe cases of acidosis,
dialysis may be considered, especially if acute renal
failure is present. The use of magnesium sulfate
has disputed benefits and should be evaluated on
a case-by-case basis27
.
It is important that medical and nursing personnel
and any person who has direct contact with
the patient be protected with gowns, gloves,
masks and special goggles during care and
decontamination, since there have been cases of
intoxication in personnel without the necessary
precautions28 .
1.5. Management of aluminum phosphide
intoxication in Argentina
In Argentina, the management of aluminum
poisoning follows the guidelines and
recommendations established by the manual
of primary care of poisoning of the country by
the Ministry of Health of the Nation Republic of
Argentina, which include:
• If dust, gases or toxic fumes are present, move
the patient to a well-ventilated area and use
respiratory protection equipment to avoid
possible poisoning. Give first aid according
to the guidelines established in Chapter
5 of Volume I - General Part. If the patient
is unconscious or drowsy, place him on his
side in the recovery position and monitor his
breathing every 10 minutes to avoid cooling.
Transport the patient to the hospital as soon
as possible29
.
• In case of delay in transport to hospital, if the
chemical has been ingested and the individual
is conscious, breathing normally and not
vomiting, administer activated charcoal and
offer water to drink. If signs of renal failure,
liver injury or pulmonary edema are observed,
treat according to the recommendations set
forth in Chapter 9 of the General Part 30.
It is important to provide the local physician with
the following information: in addition to the above
mentioned effects, acute intoxication may cause
heart rhythm disorders, while chronic intoxication
may cause liver damage, kidney damage, anemia
and electrolyte disorders (sodium, potassium,
magnesium, calcium). It is recommended to
perform a rapid and thorough gastric lavage,
monitor pulse, respiration and blood pressure,
as well as monitor liver and kidney function. In
some cases, oxygen administration and assisted
ventilation may be necessary31.
Fluids and electrolytes should also be replenished
to compensate for losses caused by vomiting and
to treat shock. There is no specific antidote and, in
the case of chronic intoxication, a complete blood
count and other tests are recommended32.
1.6. Management of aluminum phosphide
poisoning in Ecuador.
No country-specific studies were found, however,
different forums indicate that general measures
are used for the management of aluminum
phosphide poisoning in Ecuador, which indicate:
• Seek medical attention immediately: In case of
any suspicion of intoxication, it is essential to
seek medical attention as soon as possible33.
• Not delaying treatment: Time is of the essence
in cases of poisoning, so do not wait to seek
medical attention34.
• Not inducing vomiting: No attempt should be
made to make the affected person vomit, as
some chemicals may cause further damage
if they come into contact with the digestive
system again.
• Not administering home remedies: Home
remedies, milk or similar substances should
not be used in an attempt to treat poisoning,
as this may worsen the situation35.
• Providing medical information: If possible,
inform medical personnel of the substance
involved, approximate amount and time since
exposure.
• Trying to keep the affected person calm and
at rest until medical attention is received36.
A major strength of this review is the comparative
synthesis of treatment approaches reported across
several Latin American countries, offering an
MANAGEMENT OF ALUMINUM
PHOSPHIDE POISONINGVol. 16 Número 2 2025
Hydrocortisone (200-400 mg every 4-6 hours)
is also recommended to combat shock and
reduce the dopamine dose. Epinephrine may
also be an appropriate option. It is important
to maintain a well-ventilated room, as the gas
phosphine released by aluminum phosphide
poisoning is highly toxic in enclosed spaces25
As for gastrointestinal treatment, gastric lavage
as in Costa Rica. Activated charcoal with a dose
similar to El Salvador and cathartics (such as liquid
kerosene) can then be administered to accelerate
phosphate excretion. The use of vegetable oils and
proton pump inhibitors may also be beneficial26.
In cases of metabolic acidosis, sodium bicarbonate
can be used to raise serum bicarbonate levels and
correct the acidosis. In severe cases of acidosis,
dialysis may be considered, especially if acute renal
failure is present. The use of magnesium sulfate
has disputed benefits and should be evaluated on
a case-by-case basis27
.
It is important that medical and nursing personnel
and any person who has direct contact with
the patient be protected with gowns, gloves,
masks and special goggles during care and
decontamination, since there have been cases of
intoxication in personnel without the necessary
precautions28 .
1.5. Management of aluminum phosphide
intoxication in Argentina
In Argentina, the management of aluminum
poisoning follows the guidelines and
recommendations established by the manual
of primary care of poisoning of the country by
the Ministry of Health of the Nation Republic of
Argentina, which include:
• If dust, gases or toxic fumes are present, move
the patient to a well-ventilated area and use
respiratory protection equipment to avoid
possible poisoning. Give first aid according
to the guidelines established in Chapter
5 of Volume I - General Part. If the patient
is unconscious or drowsy, place him on his
side in the recovery position and monitor his
breathing every 10 minutes to avoid cooling.
Transport the patient to the hospital as soon
as possible29
.
• In case of delay in transport to hospital, if the
chemical has been ingested and the individual
is conscious, breathing normally and not
vomiting, administer activated charcoal and
offer water to drink. If signs of renal failure,
liver injury or pulmonary edema are observed,
treat according to the recommendations set
forth in Chapter 9 of the General Part 30.
It is important to provide the local physician with
the following information: in addition to the above
mentioned effects, acute intoxication may cause
heart rhythm disorders, while chronic intoxication
may cause liver damage, kidney damage, anemia
and electrolyte disorders (sodium, potassium,
magnesium, calcium). It is recommended to
perform a rapid and thorough gastric lavage,
monitor pulse, respiration and blood pressure,
as well as monitor liver and kidney function. In
some cases, oxygen administration and assisted
ventilation may be necessary31.
Fluids and electrolytes should also be replenished
to compensate for losses caused by vomiting and
to treat shock. There is no specific antidote and, in
the case of chronic intoxication, a complete blood
count and other tests are recommended32.
1.6. Management of aluminum phosphide
poisoning in Ecuador.
No country-specific studies were found, however,
different forums indicate that general measures
are used for the management of aluminum
phosphide poisoning in Ecuador, which indicate:
• Seek medical attention immediately: In case of
any suspicion of intoxication, it is essential to
seek medical attention as soon as possible33.
• Not delaying treatment: Time is of the essence
in cases of poisoning, so do not wait to seek
medical attention34.
• Not inducing vomiting: No attempt should be
made to make the affected person vomit, as
some chemicals may cause further damage
if they come into contact with the digestive
system again.
• Not administering home remedies: Home
remedies, milk or similar substances should
not be used in an attempt to treat poisoning,
as this may worsen the situation35.
• Providing medical information: If possible,
inform medical personnel of the substance
involved, approximate amount and time since
exposure.
• Trying to keep the affected person calm and
at rest until medical attention is received36.
A major strength of this review is the comparative
synthesis of treatment approaches reported across
several Latin American countries, offering an
92Cedeño Sarabia Leidy Aracely, et al.Vol. 16 Número 2 2025
3. Conclusions
4. Conflicts of interest
5. Acknowledgment
Aluminum phosphide poisoning is a serious
and potentially fatal medical condition that
can occur from ingestion, inhalation, or skin
contact. Aluminum phosphide is commonly
used as a pesticide for pest control in grain and
other agricultural storage facilities. Symptoms of
poisoning can vary depending on the route of
exposure and include gastrointestinal problems
such as nausea, vomiting, abdominal pain,
diarrhea and respiratory. In addition, there
may be symptoms related to the cardiovascular
and neurological systems, among other serious
complications, which underscores the urgency
of immediate intervention in cases of suspected
poisoning. The treatment of aluminum phosphide
poisoning is complex and requires supportive
care, including fluid resuscitation and close
monitoring of shock status. Decontamination
measures are also necessary to prevent further
absorption of the toxin. Nevertheless, supportive
care is the cornerstone of management, being
used to maintain vital body functions and to treat
the complications that can occur in the absence
of a specific antidote. In different countries, the
management of aluminum phosphide poisoning
may vary following their specific guidelines
and recommendations. It is essential that
medical and nursing personnel are adequately
protected during patient care and ensure proper
decontamination to avoid accidental exposure.
The authors declare no conflicts of interest.
I thank the authorities of the Escuela Superior
Politécnica de Chimborazo (ESPOCH) for their great
commitment and dedication in the training of
overview of current clinical management in the
absence of a specific antidote. Its main limitation
is that available treatments are largely supportive,
heterogeneous, and based on limited evidence
from case reports and national guidelines rather
than robust clinical trials. Future efforts should
focus on conducting well-designed clinical studies
to evaluate therapeutic efficacy and on developing
standardized, evidence-based treatment protocols
to improve outcomes in aluminum phosphide
poisoning.
professionals and researchers, the School of Public
Health for supporting research and the teacher for
imparting knowledge and commitment.
1. Organización Mundial de la Salud. Residuos
de plaguicidas en los alimentos. OMS - Organ
Mund la Salud [Internet]. 2022;1–4. Available
from: https://www.who.int/es/news-room/
fact-sheets/detail/pesticide-residues-in-food
2. Padilla C. Intoxicación por fosfuro de aluminio.
Med Leg Costa Rica [Internet]. 2021 [cited 2023
Jul 24];39(2215–5287):2022. Available from:
https://www.scielo.sa.cr/pdf/mlcr/v39n1/2215-
5287-mlcr-39-01-20.pdf
3. González-Andrade F, López-Pulles R, Estévez
E. Acute pesticide poisoning in Ecua-
dor: a short epidemiological report. J Pub-
lic Health. 2010;18:437–442. doi:10.1007/
s10389-010-0333-y.
4. Sevilla L. Intoxicaciones Por Fosfuro De Aluminio
en Pacientes Ingresados al Área de Medicina
Interna del Hospital César Amador Molinadel
Departamento de Matagalpa [Internet]. Nica-
ragua; 2019 [cited 2023 Jul 24]. Available from:
http://riul.unanleon.edu.ni:8080/jspui/bit-
stream/123456789/7212/1/242542.pdf
5. Rodriguez J. Intoxicación Accidental con Fosfuro
de Aluminio. Open J Syst [Internet]. 2023;21(2313
1861):1–13. Available from: http://209.45.49.25/
ojs/index.php/LEX/article/view/2530/2541
6. Villa A, Zamora X, Viera M, Vázquez M, Flores
G. Mortalidad y factores asociados con intoxi-
cación por fosfuros: estudio de cohorte prospec-
tiva. Rev Médica Inst Mex Seguro Soc [Internet].
2019;57(156–61):1–4. Available from: https://
www.medigraphic.com/cgi-bin/new/resumenI.
cgi?IDREVISTA=46&IDARTICULO=91589&IDPUB-
LICACION=8712
7. Pérez Navero JL, Ibarra de la Rosa I, Frías Pérez
MA, Arroyo Marín MJ, Pérez Jorge P. Lethal
poisoning by accidental inhalation of alumi-
num phosphide. An Pediatr (Engl Ed) [Internet].
2019 Nov [cited 2023 Jul 23];71(5):427-31. Avail-
able from: https://www.analesdepediatria.org/
es-pdf-S1695403309004652
8. Padilla C. Revista Medicina Legal de Costa Rica
Aluminum phosphide poisoning. 2021 [cited
10. References
3. Conclusions
4. Conflicts of interest
5. Acknowledgment
Aluminum phosphide poisoning is a serious
and potentially fatal medical condition that
can occur from ingestion, inhalation, or skin
contact. Aluminum phosphide is commonly
used as a pesticide for pest control in grain and
other agricultural storage facilities. Symptoms of
poisoning can vary depending on the route of
exposure and include gastrointestinal problems
such as nausea, vomiting, abdominal pain,
diarrhea and respiratory. In addition, there
may be symptoms related to the cardiovascular
and neurological systems, among other serious
complications, which underscores the urgency
of immediate intervention in cases of suspected
poisoning. The treatment of aluminum phosphide
poisoning is complex and requires supportive
care, including fluid resuscitation and close
monitoring of shock status. Decontamination
measures are also necessary to prevent further
absorption of the toxin. Nevertheless, supportive
care is the cornerstone of management, being
used to maintain vital body functions and to treat
the complications that can occur in the absence
of a specific antidote. In different countries, the
management of aluminum phosphide poisoning
may vary following their specific guidelines
and recommendations. It is essential that
medical and nursing personnel are adequately
protected during patient care and ensure proper
decontamination to avoid accidental exposure.
The authors declare no conflicts of interest.
I thank the authorities of the Escuela Superior
Politécnica de Chimborazo (ESPOCH) for their great
commitment and dedication in the training of
overview of current clinical management in the
absence of a specific antidote. Its main limitation
is that available treatments are largely supportive,
heterogeneous, and based on limited evidence
from case reports and national guidelines rather
than robust clinical trials. Future efforts should
focus on conducting well-designed clinical studies
to evaluate therapeutic efficacy and on developing
standardized, evidence-based treatment protocols
to improve outcomes in aluminum phosphide
poisoning.
professionals and researchers, the School of Public
Health for supporting research and the teacher for
imparting knowledge and commitment.
1. Organización Mundial de la Salud. Residuos
de plaguicidas en los alimentos. OMS - Organ
Mund la Salud [Internet]. 2022;1–4. Available
from: https://www.who.int/es/news-room/
fact-sheets/detail/pesticide-residues-in-food
2. Padilla C. Intoxicación por fosfuro de aluminio.
Med Leg Costa Rica [Internet]. 2021 [cited 2023
Jul 24];39(2215–5287):2022. Available from:
https://www.scielo.sa.cr/pdf/mlcr/v39n1/2215-
5287-mlcr-39-01-20.pdf
3. González-Andrade F, López-Pulles R, Estévez
E. Acute pesticide poisoning in Ecua-
dor: a short epidemiological report. J Pub-
lic Health. 2010;18:437–442. doi:10.1007/
s10389-010-0333-y.
4. Sevilla L. Intoxicaciones Por Fosfuro De Aluminio
en Pacientes Ingresados al Área de Medicina
Interna del Hospital César Amador Molinadel
Departamento de Matagalpa [Internet]. Nica-
ragua; 2019 [cited 2023 Jul 24]. Available from:
http://riul.unanleon.edu.ni:8080/jspui/bit-
stream/123456789/7212/1/242542.pdf
5. Rodriguez J. Intoxicación Accidental con Fosfuro
de Aluminio. Open J Syst [Internet]. 2023;21(2313
1861):1–13. Available from: http://209.45.49.25/
ojs/index.php/LEX/article/view/2530/2541
6. Villa A, Zamora X, Viera M, Vázquez M, Flores
G. Mortalidad y factores asociados con intoxi-
cación por fosfuros: estudio de cohorte prospec-
tiva. Rev Médica Inst Mex Seguro Soc [Internet].
2019;57(156–61):1–4. Available from: https://
www.medigraphic.com/cgi-bin/new/resumenI.
cgi?IDREVISTA=46&IDARTICULO=91589&IDPUB-
LICACION=8712
7. Pérez Navero JL, Ibarra de la Rosa I, Frías Pérez
MA, Arroyo Marín MJ, Pérez Jorge P. Lethal
poisoning by accidental inhalation of alumi-
num phosphide. An Pediatr (Engl Ed) [Internet].
2019 Nov [cited 2023 Jul 23];71(5):427-31. Avail-
able from: https://www.analesdepediatria.org/
es-pdf-S1695403309004652
8. Padilla C. Revista Medicina Legal de Costa Rica
Aluminum phosphide poisoning. 2021 [cited
10. References
93p. 87-94
MANAGEMENT OF ALUMINUM
PHOSPHIDE POISONINGVol. 16 Número 2 2025
2023 Jul 23];39(1):2022. Available at: https://
www.scielo.sa.cr/pdf/mlcr/v3 9n1/2215-5287-
mlcr-39-01-20.pdf
9. Sevilla Martínez S. Intoxications by Aluminum
Phosphide in Patients Admitted to the Area of
Internal Medicine of the Hospital César Ama-
dor Molina of the Department of Matagalpa
in the Years 2017 -2018 [Internet]. Nicara-
gua; 2019 [cited 2023 Jul 23]. Available from:
http://riul.unanleon.edu.ni:8080/jspui/bit-
stream/123456789/7212/1/242542.pdf
10. Alberto Iram Villa-Manzano. Mortality and
factors associated with phosphide poisoning:
a prospective cohort study [Internet]. Mex-
ico; 2018 [cited 2023 Jul 23]. Available from:
http://riul.unanleon.edu.ni:8080/jspui/bit-
stream/123456789/7212/1/242542.pdf
11. Salvador S, Salvador E. Clinical guideline for the
care of persons with poisoning [Internet]. 2021
[cited 2023 Jul 23]. Available from: https://biblat.
unam.mx/hevila/Revista MedicadelInstitutoM-
exicanodelSegur oSocial/2019/vol57/no3/7.pdf
12. Padilla R. Aluminum phosphide poisoning. Med
leg Costa Rica [Internet]. 2022 [cited 2023 Jul
15];-. Available from: https://search.bvsalud.org/
gim/resour ce/es/biblio-1386303
13. Salvador S, Salvador E. Clinical guide for the
care of people with poisoning [Internet]. Avail-
able at: https://docs.bvsalud.org/biblioref/202
2/01/1354120/guiaclinicaparalaatenci ondeper-
sonasconintoxicaciones- acuerdo-2968-v1.pdf
14. Quinteros Martinez ER, López Vásquez JA. Acute
pesticide poisonings epidemiology in El Salvador.
ALERT Scientific Journal of the National Institute
of Health. 2019 Jul 31;2(2):125-34.
15. Gabriel. Prehospital management of organo-
phosphate poisoning. Uceeduec [Internet]. 2022
[cited 2023 Jul 27]; Available from: http://www.
dspace.uce.edu.ec/handl e/25000/28836
16. Abraham MA, Chavez EA. Safety in the use of
aluminum phosphorus in a tobacco industry in
the province of Jujuy [Internet]. Ucasal.edu.ar.
2019 [cited 2023 Jul 27]. Available from: https://
bibliotecas.ucasal.edu.ar/opac_css/index.
php?lvl=cmspage&pageid= 24&id_notice=68568
17. Aquino C. Characteristics of occupational pesti-
cide poisoning in agricultural workers attended
at the Barranca Cajatambo Hospital 2008 - 2017.
Unmsmedupe [Internet]. 2017. [cited 2023 Jul
27]; Available from: https://cybertesis.unmsm.
edu.pe/han dle/20.500.12672/11103
18. Dayana J. Internal medicine in minor species at
Intensevet Veterinary Hospital and Vicovet Vet-
erinary Clinic in San José, Costa Rica. Unaaccr
[Internet]. 2019 [cited 2023 Jul 27]; Available
from: https://repositorio.una.ac.cr/handle/1
1056/17666
19. Padilla R, Padilla R. Aluminum phosphide poi-
soning. Medicina Legal de Costa Rica [Internet].
2022 [cited 2023 Jul 27];39(1):20-31. Available
from: https://www.scielo.sa.cr/scielo.php?p
id=S1409-00152022000100020&script=sci_
artte xt
20. Zurita Prada PA, Urrego Laurin CL, Izquierdo
Millán I. Ocular Inflammatory Pathology: Ser-
pinginous Chorioretinitis. Acta Rheumatol
[Internet]. 2016; Available from: https://www.
itmedicalteam.pl/article s/protocolo-de-mane-
jo-en-terapia- intensiva-mejora-sobrevida-en-
paciente-con-intoxicacioacuten-por- fosfu-
ro-de-aluminio-reporte-de- cas.pdf
21. Matamoros M, Castro O, Sabillón N. Pesticide
poisoning in medicolegal autopsies. Tegucigalpa
2014-2020.2023 Jun 30 [cited 2023 Jul 27];9(1):6-
13. Available from: https://camjol.info/index.
php/RCFH/a rticle/view/16158
22. Héctor Ulises Bernardino-Hernández, Ramón
Mariaca-Méndez, Austreberta Nazar-Beutel-
spacher, José David Álvarez-Solís, Torres-Dosal A,
Crispín Herrera-Portugal. Knowledge, behaviors
and symptoms of intoxication among producers
of three agricultural production systems in the
highlands of Chiapas, Mexico. 2019 Feb 1 [cited
2023 Jul 27];35(1):7-23. Available from: https://
www.scielo.org.mx/scielo.php?pid=S0188-
49992019000100007&script=sci_artte xt
23. Philip A. Toxicopathology in zinc phosphide poi-
soning. Uaemexmx [Internet]. 2022 [cited 2023
Jul 27]; Available from: http://ri.uaemex.mx/han-
dle/20.500.1 1799/113448
24. Rodríguez Padilla C. Aluminum phosphide
poisoning. Med Leg Costa Rica [Internet].
2022 [cited 2023 July 15];39(1):20-31. Avail-
able at: https://www.scielo.sa.cr/scielo.php?s
cript=sci_arttext&pid=S1409- 00152022000100
25. Medina M, Felipe Vázquez De Anda G, Monroy J.
Review of acute aluminum phosphide poisoning
MANAGEMENT OF ALUMINUM
PHOSPHIDE POISONINGVol. 16 Número 2 2025
2023 Jul 23];39(1):2022. Available at: https://
www.scielo.sa.cr/pdf/mlcr/v3 9n1/2215-5287-
mlcr-39-01-20.pdf
9. Sevilla Martínez S. Intoxications by Aluminum
Phosphide in Patients Admitted to the Area of
Internal Medicine of the Hospital César Ama-
dor Molina of the Department of Matagalpa
in the Years 2017 -2018 [Internet]. Nicara-
gua; 2019 [cited 2023 Jul 23]. Available from:
http://riul.unanleon.edu.ni:8080/jspui/bit-
stream/123456789/7212/1/242542.pdf
10. Alberto Iram Villa-Manzano. Mortality and
factors associated with phosphide poisoning:
a prospective cohort study [Internet]. Mex-
ico; 2018 [cited 2023 Jul 23]. Available from:
http://riul.unanleon.edu.ni:8080/jspui/bit-
stream/123456789/7212/1/242542.pdf
11. Salvador S, Salvador E. Clinical guideline for the
care of persons with poisoning [Internet]. 2021
[cited 2023 Jul 23]. Available from: https://biblat.
unam.mx/hevila/Revista MedicadelInstitutoM-
exicanodelSegur oSocial/2019/vol57/no3/7.pdf
12. Padilla R. Aluminum phosphide poisoning. Med
leg Costa Rica [Internet]. 2022 [cited 2023 Jul
15];-. Available from: https://search.bvsalud.org/
gim/resour ce/es/biblio-1386303
13. Salvador S, Salvador E. Clinical guide for the
care of people with poisoning [Internet]. Avail-
able at: https://docs.bvsalud.org/biblioref/202
2/01/1354120/guiaclinicaparalaatenci ondeper-
sonasconintoxicaciones- acuerdo-2968-v1.pdf
14. Quinteros Martinez ER, López Vásquez JA. Acute
pesticide poisonings epidemiology in El Salvador.
ALERT Scientific Journal of the National Institute
of Health. 2019 Jul 31;2(2):125-34.
15. Gabriel. Prehospital management of organo-
phosphate poisoning. Uceeduec [Internet]. 2022
[cited 2023 Jul 27]; Available from: http://www.
dspace.uce.edu.ec/handl e/25000/28836
16. Abraham MA, Chavez EA. Safety in the use of
aluminum phosphorus in a tobacco industry in
the province of Jujuy [Internet]. Ucasal.edu.ar.
2019 [cited 2023 Jul 27]. Available from: https://
bibliotecas.ucasal.edu.ar/opac_css/index.
php?lvl=cmspage&pageid= 24&id_notice=68568
17. Aquino C. Characteristics of occupational pesti-
cide poisoning in agricultural workers attended
at the Barranca Cajatambo Hospital 2008 - 2017.
Unmsmedupe [Internet]. 2017. [cited 2023 Jul
27]; Available from: https://cybertesis.unmsm.
edu.pe/han dle/20.500.12672/11103
18. Dayana J. Internal medicine in minor species at
Intensevet Veterinary Hospital and Vicovet Vet-
erinary Clinic in San José, Costa Rica. Unaaccr
[Internet]. 2019 [cited 2023 Jul 27]; Available
from: https://repositorio.una.ac.cr/handle/1
1056/17666
19. Padilla R, Padilla R. Aluminum phosphide poi-
soning. Medicina Legal de Costa Rica [Internet].
2022 [cited 2023 Jul 27];39(1):20-31. Available
from: https://www.scielo.sa.cr/scielo.php?p
id=S1409-00152022000100020&script=sci_
artte xt
20. Zurita Prada PA, Urrego Laurin CL, Izquierdo
Millán I. Ocular Inflammatory Pathology: Ser-
pinginous Chorioretinitis. Acta Rheumatol
[Internet]. 2016; Available from: https://www.
itmedicalteam.pl/article s/protocolo-de-mane-
jo-en-terapia- intensiva-mejora-sobrevida-en-
paciente-con-intoxicacioacuten-por- fosfu-
ro-de-aluminio-reporte-de- cas.pdf
21. Matamoros M, Castro O, Sabillón N. Pesticide
poisoning in medicolegal autopsies. Tegucigalpa
2014-2020.2023 Jun 30 [cited 2023 Jul 27];9(1):6-
13. Available from: https://camjol.info/index.
php/RCFH/a rticle/view/16158
22. Héctor Ulises Bernardino-Hernández, Ramón
Mariaca-Méndez, Austreberta Nazar-Beutel-
spacher, José David Álvarez-Solís, Torres-Dosal A,
Crispín Herrera-Portugal. Knowledge, behaviors
and symptoms of intoxication among producers
of three agricultural production systems in the
highlands of Chiapas, Mexico. 2019 Feb 1 [cited
2023 Jul 27];35(1):7-23. Available from: https://
www.scielo.org.mx/scielo.php?pid=S0188-
49992019000100007&script=sci_artte xt
23. Philip A. Toxicopathology in zinc phosphide poi-
soning. Uaemexmx [Internet]. 2022 [cited 2023
Jul 27]; Available from: http://ri.uaemex.mx/han-
dle/20.500.1 1799/113448
24. Rodríguez Padilla C. Aluminum phosphide
poisoning. Med Leg Costa Rica [Internet].
2022 [cited 2023 July 15];39(1):20-31. Avail-
able at: https://www.scielo.sa.cr/scielo.php?s
cript=sci_arttext&pid=S1409- 00152022000100
25. Medina M, Felipe Vázquez De Anda G, Monroy J.
Review of acute aluminum phosphide poisoning
94Cedeño Sarabia Leidy Aracely, et al.Vol. 16 Número 2 2025
[Internet]. 2012 p. 242-6. Available at: https://
www.medigraphic.com/pdfs/ medcri/ti-2012/
ti124i.pdf
26. Medina M, Felipe Vázquez De Anda G, Monroy J.
Review of acute aluminum phosphide poisoning
[Internet]. 2012 p. 242-6. Available from: https://
www.medigraphic.com/pdfs/ medcri/ti-2012/
ti124i.pdf
27. Docampo PC, Spera M, Voitzuk AP. Case series
of fatal poisoning by intentional ingestion of alu-
minum phosphide: case reports with fatal evolu-
tion. Acta toxicológica argentina [Internet]. 2014
[cited 2023 Jul 27];22(3):136-40. Available from:
http://www.scielo.org.ar/scielo.php?s cript=sci_
arttext&pid=S1851- 37432014000300004
28. Padilla R. Aluminum phosphide poisoning. Med
leg Costa Rica [Internet]. 2022 [cited 2023 Jul
27];-. Available from: https://search.bvsalud.org/
gim/resour ce/es/biblio-1386303
29. Table:1 Pathophysiology of acute aluminum
phosphide poisoning [Internet]. 1library.co. 2021
[cited 2023 Jul 27]. Available from: https://1li-
brary.co/article/cuadro- fisiopatolog%C3%ADa-
intoxicaci%C3%B3n-aguda-fosfuro- aluminio.
q7w0g94d
30. J.L. Pérez Navero, Rosa, M.A. Frías Pérez, Marin
M, Jorge. Lethal poisoning by accidental inha-
lation of aluminum phosphide. 2009 Nov 1
[cited 2023 Jul 27];71(5):427-31. Available from:
https://www.analesdepediatria.org/es-intoxica-
cion-letal-por-inhalacion- accidental-articulo-
S1695403309004652
31. Unit i poisoning - aluminum phosphide poison-
ing - urgency and emergency [Internet]. Slide-
share.net. 2016 [cited 2023 Jul 27]. Available
from: https://es.slideshare.net/doctorcitage a/
unidad-i-intoxicacines-intoxicacin- por-fosfu-
ro-de-aluminio-urgencia-y- emergencia
32. Salud pública de Argentina, Manual de atención
primaria de intoxicaciones Tomo II Parte Especial
[Internet]. [cited 2023 Jul 15]. Available from :
https://www.argentina.gob.ar/sites/d efault/
files/manual_toxi.pdf
33. Alberto Iram Villa-Manzano, X. Xitlalli Zamo-
ra-López, Huerta-Viera M, María Guadalupe
Vázquez-Solís, Gildardo David Flores-Robles.
Mortality and factors associated with phosphide
poisoning: a prospective cohort study. Revista
Médica del Instituto Mexicano del Seguro Social
[Internet]. 2019 [cited 2023 Jul 27];57(3):156-61.
Available from: https://www.redalyc.org/jour-
nal/457 7/457762231007/html/
34. Pedro. Aluminum phosphide poisoning (love
pill, bean curing pill) [Internet]. Blogspot.
com. 2023 [cited 2023 Jul 27]. Available from:
https://drpaso.blogspot.com/2011/05/intoxica-
cion-por-fosfuro-de- aluminio.html
35. Mauricio Reyna Medina, Anda GV, Monroy J.
Review of acute aluminum phosphide poison-
ing [Internet]. ; 2013 [cited 2023 Jul 27]. Available
from: https://www.semanticscholar.org/pap er/
Revisi%C3%B3n-de-la- intoxicaci%C3%B3n-agu-
da-por- fosfuro-de-Medina- Anda/40ea9dbba-
8be1bcc1117ac8836 140b1bb094c201
36. O'Malley GF, Rika O'Malley. Organophos-
phate and carbamate poisoning [Internet].
MSD manual practitioner's version. MSD
Manuals; 2022 [cited 2023 Jul 27]. Available
from: https://www.msdmanuals.com/es/
pr ofessional/lesiones-y-envenenamientos/
intoxicaci%C3%B3n/envenenamiento-con- orga-
nofosforados-y-carbamato
[Internet]. 2012 p. 242-6. Available at: https://
www.medigraphic.com/pdfs/ medcri/ti-2012/
ti124i.pdf
26. Medina M, Felipe Vázquez De Anda G, Monroy J.
Review of acute aluminum phosphide poisoning
[Internet]. 2012 p. 242-6. Available from: https://
www.medigraphic.com/pdfs/ medcri/ti-2012/
ti124i.pdf
27. Docampo PC, Spera M, Voitzuk AP. Case series
of fatal poisoning by intentional ingestion of alu-
minum phosphide: case reports with fatal evolu-
tion. Acta toxicológica argentina [Internet]. 2014
[cited 2023 Jul 27];22(3):136-40. Available from:
http://www.scielo.org.ar/scielo.php?s cript=sci_
arttext&pid=S1851- 37432014000300004
28. Padilla R. Aluminum phosphide poisoning. Med
leg Costa Rica [Internet]. 2022 [cited 2023 Jul
27];-. Available from: https://search.bvsalud.org/
gim/resour ce/es/biblio-1386303
29. Table:1 Pathophysiology of acute aluminum
phosphide poisoning [Internet]. 1library.co. 2021
[cited 2023 Jul 27]. Available from: https://1li-
brary.co/article/cuadro- fisiopatolog%C3%ADa-
intoxicaci%C3%B3n-aguda-fosfuro- aluminio.
q7w0g94d
30. J.L. Pérez Navero, Rosa, M.A. Frías Pérez, Marin
M, Jorge. Lethal poisoning by accidental inha-
lation of aluminum phosphide. 2009 Nov 1
[cited 2023 Jul 27];71(5):427-31. Available from:
https://www.analesdepediatria.org/es-intoxica-
cion-letal-por-inhalacion- accidental-articulo-
S1695403309004652
31. Unit i poisoning - aluminum phosphide poison-
ing - urgency and emergency [Internet]. Slide-
share.net. 2016 [cited 2023 Jul 27]. Available
from: https://es.slideshare.net/doctorcitage a/
unidad-i-intoxicacines-intoxicacin- por-fosfu-
ro-de-aluminio-urgencia-y- emergencia
32. Salud pública de Argentina, Manual de atención
primaria de intoxicaciones Tomo II Parte Especial
[Internet]. [cited 2023 Jul 15]. Available from :
https://www.argentina.gob.ar/sites/d efault/
files/manual_toxi.pdf
33. Alberto Iram Villa-Manzano, X. Xitlalli Zamo-
ra-López, Huerta-Viera M, María Guadalupe
Vázquez-Solís, Gildardo David Flores-Robles.
Mortality and factors associated with phosphide
poisoning: a prospective cohort study. Revista
Médica del Instituto Mexicano del Seguro Social
[Internet]. 2019 [cited 2023 Jul 27];57(3):156-61.
Available from: https://www.redalyc.org/jour-
nal/457 7/457762231007/html/
34. Pedro. Aluminum phosphide poisoning (love
pill, bean curing pill) [Internet]. Blogspot.
com. 2023 [cited 2023 Jul 27]. Available from:
https://drpaso.blogspot.com/2011/05/intoxica-
cion-por-fosfuro-de- aluminio.html
35. Mauricio Reyna Medina, Anda GV, Monroy J.
Review of acute aluminum phosphide poison-
ing [Internet]. ; 2013 [cited 2023 Jul 27]. Available
from: https://www.semanticscholar.org/pap er/
Revisi%C3%B3n-de-la- intoxicaci%C3%B3n-agu-
da-por- fosfuro-de-Medina- Anda/40ea9dbba-
8be1bcc1117ac8836 140b1bb094c201
36. O'Malley GF, Rika O'Malley. Organophos-
phate and carbamate poisoning [Internet].
MSD manual practitioner's version. MSD
Manuals; 2022 [cited 2023 Jul 27]. Available
from: https://www.msdmanuals.com/es/
pr ofessional/lesiones-y-envenenamientos/
intoxicaci%C3%B3n/envenenamiento-con- orga-
nofosforados-y-carbamato