BACKGROUND & OBJECTIVE: Metallic phosphide pesticides are known pesticide in Iran. Aluminum phosphide in different regions of Iran especially is used as a "RICE TABLET" and is a cause of poisoning and mortality every year. They are highly toxic, low cost, and easily accessible fumigant and rodenticidal agent in Iran. Their toxicity results from the liberation of phosphine gas upon exposure to moisture, which leads to multi system involvement resulting in serious consequences. In acute oral intoxication, the clinical presentations of poisoning include gastrointestinal, cardiovascular, hepatic, renal and neurological disorders. Treatment is symptomatically and has not a specific antidote. The aim of this article is a review on phosphide toxicology and poisoning control.  

Introduction: Aluminum phosphid (AlP) or RICE TABLET is one of the most common pesticides in the world. Exposure of AlP with water, steam and gastric acid produces phosphin gas (PH3) that results in poisoning. AlP poisoning is widely used for suicide in adolescent and young adult. Two third of poisoned patients expire Objective: The goal of this research was to study epidemiological, clinical and laboratory changes in poisoned patients Materials and Methods: In this cross sectional study the medical charts of 116 patients who were admitted to Razi hospital from April 2000 to December 2003 was reviewed. Data such as age, sex, residency, number of TABLET that used, the time between poisoning & admission, vital sign & lab data such as electrolytes & ABG were gathered from patients charts & entered into the check list previously provided Results: In this study 54.3% of patients were male. Mean age was 29.47±14.79 years & 41.2% of patients committed suicide with one TABLET, 78.4% had GI manifestations, mean of systolic blood pressure was 87.48±28.66 mmHg & the time between poisoning & admission of this patients, number of TABLET used, systolic blood pressure, HCO3, PH & O2 saturation were related to mortality rate (P<0.05) Conclusion:  From the total patients, 68 (58.61%) of them died. Using these results and correlation of mortality rate with the time between poisoning and admission of these patients, number of TABLETs used, systolic blood pressure, HCO3, PH & O2 saturation, we can use these data for further studies to estimate the prognosis of these patients. 

Background: Aluminum phosphide (ALP) is an inorganic phosphide used to control insects and rodents in a variety of settings. In has extensive domestic consumption, commonly for storing RICE in Iran. In this study we objectively demonstrate the frequency of fatal complications of poisoning due to aluminum phosphide (ALP) in patients referred to Loghman Hospital’s Center for Toxicological, Tehran, Iran.Aluminium phosphide is an inorganic compound, used as a rodenticide, insecticide, for stored cereal grains.In Iran Known as “RICE TABLET, for its use to preserve RICE. The toxicity of aluminium phosphide is attributed to the liberation of phosphine gas in contact with with water or weak acid and is the major cause of poisoning and deaths. RICE TABLET (Alminume Phosphid) poisoning may be associated with Serious and sometimes incurable complications. The aim of this study, is to assess the Prevalence of complications leading to death in patients with acute Alminume Phosphid poisoning Method: A retrospective cross sectional study of 111 self-poisoned patients with history of single agent“ RICE TABLET” ingestion admitted to Loghman-Hakim hospital poison center, Tehran, Iran, along two years period, from, 1392-1389.Findings: Out of 111 patients included in this study, 60 patients (54.1%) were male and 51 patients (45.9%) were female with Mean age and standard deviation of 26±8.9. Minimum and maximum age rang was between 15 and 43 years. Uniform ingestion were reported in 61.3% (68 patients).Dose consumption ranges from ¼ TABLET in 39 (35.1%) case to more than one TABLET in 32 (28.2%) cases. Post ingestion times in 36% were within last one hours at the arrivals to Emergency Department. Vomiting was the most common symptoms reported by 107 (96.4%) patients at their owne places. Agittation in 36.9% (41 cases) and felling of thirsty in 27.9% (31 cases) reported by physician in duty of Emergeny department.Conclusion: Although maney complications such as Hypotension, Adult Respiratory Distress Syndrom (ARDS), Acute Renal Failure (ARF) AND Multi Organ Failure (MOF) were the common complications observed in these patients, but the most lethal complication was Cardiac Arrhythmias occurred in in 41 (36.9%) of cases.

Aluminum phosphide is a cheap and highly toxic pesticide which is commonly used for grain preservation. In Iran, it is known as the “RICE TABLET”. Ingestion of only 1.5 g of a standard TABLET (3000 mg) could be lethal in humandue to multiple organ failures. Unfurtunately, this high potent toxic substance is easily available in our country. Its usage for suicidal attempts has been increasing significantly in recent years. According to the availability of garlic deragee, herbal RICE TABLET (Banan) and aluminum phosphide, all three in Iranian market as “garlic TABLET”, we may meet unintentional fatal poisoning caused by accidental ingestion of aluminum phosphide in some cases.In this manuscript, we report a successful treatment in two patients with accidental poisoning by aluminum phosphide which had happened due to nominal similarity.

Background: The poisoning is mostly due to suicide and is observed in younger age groups. The systemic manifestations of ALP poisoning are common but pernicious manifestations of them are cardiotoxicity, shock, and ARDS. The clinical hallmark of cardiotoxicity is arrhythmia. The aim of this study was to investigate cardiac arrhythmias in patients poisoned with ALP who were admitted to Razi Hospital to reduce mortality rate.Methods: This survey was performed as a cross sectional descriptive study. Overall, 102 patients were admitted to the hospital. Their gender, age, first blood pressure (BP), and the number of consumed TABLET were registered. A cardiologist studied the patients’ ECGs and recorded various arrhythmias. Then, data were analyzed using SPSS version 11.Results: In this study the mean age was 29.75±14.34 years and 66.7% of the patients were male. Used TABLET and first BP average were 1.74±1.25 and 69.51±27.31 mmHg, respectively.Arrhythmia was recorded in 75.5% of the patients, among which arterial fibrillation (AF) was the most prevalant with the rate of 40.3%. PVC, Junc and PAC were the most common arrhythmias, respectively. Another arrhythmia was categorized in one group. All kinds of arrhythmia were common in younger males who had used more than one TABLET and had first BP less than 90 mmHg. All patients with arrhythmia died.Conclusion: Cardiotoxicity is an important cause of death in all studies and in this study as well. All patients with arrhythmia, demonstrated through ECG, died. Therefore, this study can be the basis for more detailed studies.

Background: Aluminum phosphide or RICE TABLET is a solid disinfectant that globally used to protect cereal crops from insects and rodents. However in recent years, due to its easy accessibility; the youth used it for suicide. In this study, related factors in pulmonary edema and aspiration pneumonia among RICE TABLET poisonings were investigated.Materials and methods: This study examined the clinical records of 67 patients with acute oral toxicity as a result of consumption aluminum phosphide admitted in Bahrlo hospital as well as 28 files of autopsy in Kahrizak forensic research center. Recorded data included patients’ gender, aspiration pneumonia, and pulmonary edema. The data was analyzed using the software SPSS ver.16.Results: All patients received standard conservative therapy. Out of 67 patients, 30 (%44.8) were male. A significant correlation was also found between patients’ age and aspiration pneumonia (p=0.035), so that the older patients have more possibility to engage the aspiration pneumonia. The mean age of patients with and without aspiration pneumonia was 36.75±14.45 and 24.92±10.43. In addition, the mortality risk was 1.5 times more in patients with pulmonary edema.Conclusion: Aluminum phosphide poisoning is a topical issue in public health. This study investigated some consequences of aluminum phosphide consumption. The results of this study can help to facilitate the prevention and treatment of RICE TABLET poisoning.

Introduction: ALuminium Phosphide (ALP) or RICE TABLET is one of the most commonly used pesticides in agriculture. Exposure of ALP with water, moisture and gastric acid produced phosphine gas (PH3) that caused to poisoning. Several histopathogical researches have shown edema, congestion, and leukocyte infiltration in different organs. More pathological researches are obviously required to describe the mechanism of poison affects on cells. Objective: To determine the histopathological findings in autopsy of liver, myocardium, and lungs of poisoned patients with RICE TABLET. Materials and Methods: This retrospective descriptive study was conducted on 80 poisoned patients with phosphine in the histopathology department of the legal medicine organization of Guilan in the years of 2001-2006. Stained sections of the liver, myocardium and lungs of poisoned patients were reviewed and histopathological findings were recorded. Data were analyzed by SPSS Ver.15 software. Results: According to the data analysis, 60% of patients were male and the rest (40%) were female. Mean age was 31.45 years. Histopathological findings in liver were: Sinusoidal congestion (45%), fatty liver changes (20%), congestion of central vein (15%), fine cytoplasmic vacuoles (10%), PMN leukocyte clusters in Sinusoids (7%), nuclear fragmentation (2%), centri lobular necrosis (1%). Histopathological findings in myocardium were: congestion (86%), necrosis (7%) and leukocyte infiltration (7%).  Histopathological findings in lungs were: edema (42%), congestion (33%), hemorrhage (11%), atelectasia (11%), capillary dilatation (2%), and thickening of alveolar septae (1%). Conclusion: In this study, it was discovered that the most common histopathological finding in liver of poisoned patients with phosphine were sinusoidal congestion and fatty liver changes. Meanwhile, edema and congestion were the most common in autopsy of lungs. Congestion was the mostly-observed histopathological finding of myocardium.

Background: Accidental and intentionally poisoning caused by RICE TABLETs (aluminum phosphide) are relatively common in Iran, and lead to insignificant complications and deaths every year. In this case report, we introduce a case of RICE TABLETs poisoning with nervous system symptoms and different findings in brain magnetic resonance imaging (MRI). Case Report: The case was a 28-years-old man who intentionally consumed RICE TABLETs, and was referred to emergency department with dyspnea, dizziness, dull abdominal pain, nausea, and loss of consciousness. Examinations demonstrated a sharp drop in blood pressure, cold hands and feet, and increased heart rate. Emergency support measures were performed for the patient. During the hospitalization, the patient experienced an exacerbation of systemic symptoms and loss of consciousness, as well as right side hemiparesis. MRI images showed parenchymal hemorrhages of the cerebral hemispheres with diffuse and severe cerebral edema, numerous small and diffuse areas of bleeding, and symptoms of acute diffuse leukoencephalopathy. Conclusion: Imaging techniques such as MRI can be deployed for the diagnosis of neurological toxic effects (e. g., stroke, bleeding, white matter changes, and brain edema) caused by RICE TABLETs poisoning.