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Background: Poisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years.Methods: We performed a systematic literature review in Medline, Embase and Google Scholar (1999-2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study.Results: We identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999-2003), the number of deaths declining thereafter (to n = 1714 in 2014-2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths.Conclusion: Use of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter's lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions. [ABSTRACT FROM AUTHOR]

Aluminum phosphide (ALP) is a pesticide agent and infrequent culprit of accidental poisoning. We present a case of severe reversible cardiomyopathy and left ventricular apical thrombus in a patient who worked as an exterminator and had ALP poisoning. [ABSTRACT FROM AUTHOR]

“Caution is advised while decontaminating a victim of poisoning. Over enthusiasm may result in the patient, not the poison” – John Morrision Poisoning has been known to mankind since time immemorial and the study of various poisons and their effects has always fascinated mankind. References to poisons and various instances of poisoning are available in Indian Shastras, Egyptian Papyari and Sumerian writings.1 Since then many substances considered advantages and disadvantages in the form of food or poisons have been discovered. Those substances which are used unfortunately to take away the man’s life or cause ill health have been changing. Some of the great persons who were poisoned to death are Chatrapati Shivaji Maharaj,2-3 whose bed was poisoned, Socrates, who was made to drink Hemlock (Conium maculatum) and Rasputin who was poisoned with cyanide and then shot. Aluminum phosphide poisoning, a rodenticide is also posing a formidable challenge and is on the way for taking the number one position. As poisoning trends go on changing, it is necessary to know the poisoning trends from time to time. [ABSTRACT FROM AUTHOR]

In grain-filled containers, Aluminum Phosphide (AlP) 56% a.i. tablet was applied at three vertical locations i.e., bottom, middle and top to study the release and dissemination pattern of phosphine gas. The bottom application has recorded the highest concentration of phosphine at the container bottom with a concentration of 1975 ppm on 1st day of application and the mean concentration was recorded as 568.1 ppm in the 10-day observation period. Application at the middle of the grain bins has also recorded the highest mean concentration of 436.1 ppm phosphine at the bottom only, due to more downward movement of the gas. The top application of the AlP tablets also has resulted in downward movement of the gas and caused the presence of considerable levels of phosphine at the bottom equal to that of the application site. In a sealed empty container under 58% atmospheric relative humidity, phosphine release was found slower and it was detected on the 2nd day of application only. In the grain bins, the moisture present in the grains has caused the immediate and fast release of phosphine gas from AlP tablets. The bottom monitoring line has recorded the highest mean phosphine concentration from all the containers whether they are filled or empty. The downward movement of phosphene implies the middle and top application of AlP in stocks for fumigation to be effective by even distribution of the toxic phosphine gas. [ABSTRACT FROM AUTHOR]

• Exposure to AlP can lead to human poisoning by severely damaging mitochondrial DNA.. • Mitochondria shield cells from stress and stimulate the immune system by releasing damage-associated molecular patterns. • Mitochondrial imbalance can trigger excessive immune response, causing organ dysfunction. • Mitochondrial dysfunction is closely linked to the activation of NLRP3. • Targeting the NLRP3 inflammasome could be a promising strategy for developing antidotes for AlP poisoning. Aluminum phosphide (AlP) is a fumigant used to control pests. However, human exposure to this substance can lead to poisoning. AlP reacts with gastric acid and water to release phosphine (PH3). This toxic gas affects the mitochondria and quickly enters the bloodstream. This gas impairs the mitochondria's ability to generate ATP, leading to oxidative stress, mitochondrial dysfunction, and damage to mitochondrial DNA (mt-DNA). Mitochondria release damage-associated molecular patterns (DAMPs) to shield cells from stress and stimulate the innate immune system. Nonetheless, if mitochondrial homeostasis is disrupted, an excessive immune response can occur, causing organ dysfunction. Mitochondrial reactive oxygen species (mt-ROS) and mt-DNA act as DAMPs. Upon recognition of DAMPs, the inflammasome is activated, causing inflammation. The nucleotide-binding domain, leucine-rich-containing family, and pyrin domain-containing-3 (NLRP3) gene on chromosome 1's extended arm encodes a protein that triggers the human inflammasome. NLRP3 is the most extensively researched inflammasome subfamily. It is essential to recognize that the pathophysiology of mitochondrial dysfunction and NLRP3 activation is complex and multifactorial, and a comprehensive approach may be needed to address both the underlying causes and downstream inflammatory responses effectively. The cGAS-STING pathway is essential for immune responses, and targeting specific nodes can be beneficial. Therapeutic approaches include small molecule drugs, biologics, vaccines, and combination therapies. Since there is a significant relationship between mitochondrial events and NLRP3 activation, targeting this inflammasome could be a promising strategy for developing antidotes for AlP poisoning. [ABSTRACT FROM AUTHOR]

Aluminum phosphide (AlP) is an important fumigant, a commendable and very effective outdoor and indoor insecticide. AlP, locally named “rice tablet”, is widely used to protect rice. As soon as taking a very small amount of an AlP tablet, phosphine vaporizes due to the exposure to the air and affects different kinds of organs. Although, in most cases, clinical history can help making the final diagnosis, analytical tests such as gas chromatographic method in post-mortem specimens and survivors have been developed to measure the level of phosphine and to distinguish between ZnP and AlP poisoning. AlP poisoning management should be started quickly. In addition to supportive therapy, various antioxidant agents, as candidate protective factors, such as N-acetylcysteine (NAC), melatonin, glutathione, magnesium, β-carotene, and vitamin C and E have also been recommended to decrease oxidative damage and cardiotoxicity due to the limited antioxidant defense systems. The present study highlights the fact that Antioxidant therapy in severe ALP poisoning confers different survival benefits. This literature review showed that the administration of antioxidant therapy in addition to the supportive treatment may decrease the mortality rate and could be considered in the treatment of acute AlP poisoning in combination with other therapeutic protocols.

Background: Metal phosphides are widely used as a rodenticide and insecticide and poisoning with these substances has a very high mortality. The aim of this study was to evaluate the butyrylcholinesterase (BuCh) level in poisoning with metal phosphides. Methods: In this case series study, 60 poisoned patients with zinc phosphide (ZnP) and aluminum phosphide (ALP) who was admitted to poisoning ward in Hamadan, Iran, enrolled in the study and BuCh level was measured. The sex, age, amount of ingestion, time of consumption, signs and symptoms, ECG and arterial blood gas (ABG) changes and clinical outcomes were evaluated. Results: Most (58.3%) patients were males, the mean age was 32.76±17.65 years. The average amount of ingestion was 7.5±4.6 and 2.5±2.96 gr for ZnP and ALP, respectively. Most signs and symptoms were hypotension (97%), nausea and vomiting (82%) and abdominal pain (32%). The average amount of BuCh level in all patients was 5163.25±2158.31 U/L, that's while in ZnP and ALP poisoned patients was 5608±1577 U/L and 4721.46±2562U/L respectively. The most dysrhythmia (26.7%) was sinus tachycardia. Acidosis was seen in 33.3% of patients. 14 patients died after hospital admission, which caused a 23.3% fatality rate. Conclusion: Our results showed that, there was no significant change in BuCh level in poisoned patients with phosphide compounds.

Background: Given the fact that various studies have reported the positive effects of hydroxyethyl starch therapy in controlling shock, this study aimed to compare the effects of hydroxyethyl starch on modifying acidosis and treating patients with aluminum phosphide poisoning. Methods: This was a randomized clinical trial that was conducted on 60 patients with aluminum phosphide poisoning. We compared the two groups of patients treated with hydroxyethyl starch and normal saline. Base excess and serum pH of arterial blood gases (ABG) were measured before and after the treatment and compared by t-test. Results: Results showed that arterial pH in the starch group and normal saline group increased by 0.13 and 0.18, respectively, and the difference between the two groups was not statistically significant. The difference in the base excess before and after treatment in the starch group and normal saline group was 6.41 and 5.39, respectively, and the difference between the two groups was not statistically significant. Changes in mean values of arterial pH after the intervention in comparison with before treatment were statistically significant (p

Objectives: Cardiotoxicity is considered the primary cause of death in aluminum phosphide (ALP)-poisoned cases. Curcumin, the active ingredient of turmeric, is a potent protective polyphenol compound against cardiac diseases including cardiotoxicity. This study aimed to examine the probable cardioprotection potential of nanocurcumin in a rat model of ALP-induced cardiotoxicity. Methods: The rats were orally intoxicated with ALP (12 mg/kg, p.o.; 1/4 LD50). In treatment groups, curcumin (50 mg/kg, i.p.) and nanocurcumin (10, 20 and 50 mg/kg, i.p.) were administered intraperitoneally 30 min following ALP administration. Twenty four hrs subsequent to ALP intoxication, the hearts were dissected out for evaluation of oxidative stress and lipid peroxidation (LPO) markers such as thiol, reactive oxygen species (ROS), superoxide dismutase (SOD), glutathione (GSH) levels, malondialdehyde (MDA) and the ferric reducing ability of plasma (FRAP). Findings: In fact, ALP increased MDA as well as ROS and SOD levels. On the other hand, ALP significantly lowered thiol, GHS and FRAP markers. In contrast, nanocurcumin successfully could reverse the increases in MDA as well as SOD, ROS and GSH. Simultaneously, it significantly enhanced thiol, GHS and FRAP markers. Moreover, curcumin markedly lowered MDA, ROS and SOD levels while increased thiol and GSH contents. Conclusion: Overall, the present data demonstrated the cardio-protective effects of nanocurcumin in this model of cardiotixicity. Further, it suggested that this cardioprotecton is probably mediated by the ability of nanocurcumin to confront the oxidative stress and LPO resulting from ALP intoxication of the heart tissue. Key words: Nanocurcumin; aluminum phosphide; cardiotoxicity; oxidative stress; rat.

Aluminum Phosphide (AIP) poisoning is one of the major causes of mortality among toxic substances. The symptoms and signs of toxicity are nonspecific and related to dose and route of exposure. A 20-year-old woman was admitted to the emergency department due to the consumption of one AIP tablet. ECG was normal at 2 hours post-ingestion and echocardiography revealed LVEF of 55-60% at 4 hours post admission. ECG abnormalities in this patient included VT and VF on the second night. She experienced an unusual rhythm disturbance in term of LBBB and Brugada pattern besides low ejection fraction of left ventricue (about 20-25%) on the third day. The main emphasis for AIP poisoning cases is on a timely, precise and prompt symptomatic treatment.

The use of kola nut, including natural or alternative medicinal sources, has inevitably created an increased global market demand in excess of its production and provides great prospects for the growth of the kola nut industry in producing countries like Ghana. Nonetheless, there is a great dearth of information on Ghana's kola nut supply-side practices and constraints that can provide a basis for the development of the industry. This study fills the research gap by describing the practices and constraints of farmers, processors, and marketers of kola nut in Ghana. Using a survey methodology, results showed that nearly all (99.5%) farmers interviewed had not received any extension training on agronomic practices. Low market price of nuts (61.5%) and pests and diseases (60.4%) were the most reported constraints to kola nut production. Chiefs among motivating factors for cultivating kola nut were alternative livelihood support (58%). Some processors (28.6%) who rinsed nuts after depulping used a solution of Akate Master (bifenthrin) and others (51.0%) used fumigation tablets (aluminium phosphide) (91.0%) for storing the nuts. However, these chemicals may be dangerous to the health of consumers in the long run. The low selling price of kola nuts was perceived to be the most (74.8%) constraint to kola nut processing and marketing. Respondents noted that the red nuts were preferred for their durability during transportation and longer shelf life, while the white nuts were preferred for their taste. The results suggest the need for further agronomic, postharvest handling, preservation, and storage, as well as breeding research to provide recommendations to farmers and processors. To overcome some marketing challenges, there is a need for policy support to standardize pricing and grading systems for the mutual benefit of all the stakeholders. [ABSTRACT FROM AUTHOR]

Aluminum phosphide (AlP) is an agent mostly used for it`s pesticide properties. It is the major cause of suicide poisoning associated with high mortality in Albania. As soon as AlP is exposed to a moisture environment it undergoes a reaction producing phosphine, a gas which is lethal. It inhibits cytochrome C oxidase and then it causes cell hypoxia due to the inhibition of oxidative phosphorylation. The signs and symptoms are not specific, even though nausea, vomiting, abdominal cramps and hypotension are almost always present. The diagnosis is made mainly by clinical history of the patient and clinical presentation. AlP poisoning has no antidote, and the treatment is mainly focused on symptom management, and supportive measures. This article, represents three cases of aluminium phosphide poisoning, two young girls and one young man. All of them were hospitalized due to the diagnosis of Aluminum phosphide poisoning. The diagnosis was made from clinical presentation of the patients and medical history taken mostly from them and their relatives. Two of the patients presented with abdominal pain, nausea, vomiting with characteristic garlic odor, hypotension, cyanosis, and severe metabolic acidosis. Both survived. The other one, a young girl, was taken to hospital by her friends. She was conscious, cooperative with mild and nonspecific symptoms on arrival. On the fifth day she died. Conclusion: There is still a lot to know about pathological mechanisms of AlP poisoning, the best treatment that can be offered to a specific patient and the right time when it should be applied. [ABSTRACT FROM AUTHOR]

Objectives: To study the prevalence of aluminum phosphide intoxication reported to Forensic Medicine and Toxicology Department. Material and Methods: Retrospective chart review was conducted on the victims of aluminum phosphide poisoning out of the total autopsies conducted at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar, from January 2019 to December 2019. The cases were identified on the basis of postmortem findings, laboratory results and the police inquest report. SPSS 20.0 was used as a statistical tool for the study. Results: A total of 940 cases of poisoning were received, out of which 99 were of aluminum phosphide intoxication making a percentage of 10.5%. Amongst these 70 were females and 29 were males. The most commonly affected age group is 11-20 years among females and 21-30 years among males and intoxication was more common in rural than in urban areas. Conclusion: Aluminum phosphide (wheat pills) is one of the most commonly used substance for poisoning among young people. More prevalent in rural areas, due to easy availability with a maximum number of cases received in the month of December. [ABSTRACT FROM AUTHOR]

Background: The prevalence of aluminium phosphide (AlP) poisoning is on the rise in Asian countries. The objectives of our study were to determine the distribution of AIP poisoning by sex, age groups & district and its presentation by blood pressure category and oxygen saturation category and its mortality in Khyber Pakhtunkhwa Province, Pakistan. Materials & Methods: This cross-sectional study was conducted at Emergency Department of Lady Reading Hospital, Peshawar, Pakistan from June 1, 2020 to September 30, 2020. Fifty eight cases of AIP registered during 2019 were included. The diagnosis was made by history and clinical suspicion. All these cases were managed by standard management protocols. Sex, age groups, district, blood pressure category, oxygen saturation category and presence of mortality were variables; all being categorical were analyzed by count and percentage with 80% confidence interval. Results: Out of 58 AlP poisoning cases, women 34 (58.62%) were more than men 24 (41.38%), with most cases 30 (51.73%) in 10-19 years age group. Most cases 17 (29.31%) were from district Swabi, followed by district Peshawar 16 (27.58%). Most cases presented in non-recordable blood pressure category 19 (32.76%). Most cases 22 (37.93%) presented in oxygen saturation category of = 90%. Out of 58 cases, mortality was 72.41% (42/58), involving more women 24/58 (41.38%) than men 18/58 (31.03%), with most cases 23 (39.66%) in 10-19 years age group. Mortality was highest in non-recordable blood pressure category 19 (32.76%). Mortality was highest 19 (32.76%) in oxygen saturation category of below 90%. Conclusion: Aluminium phosphide (AlP) poisoning is an uncommon, but a dreadful public health problem in population of Khyber Pakhtunkhwa Province, Pakistan. It involves women more than men, with most cases in adolescent age group, and in non-recordable blood pressure category. AlP poisoning mortality is very high 72.41% in our population, involving more women than men, with most cases in adolescent age group. Mortality is highest in non-recordable blood pressure category and in oxygen saturation category of below 90%. [ABSTRACT FROM AUTHOR]

Background: Poisoning is a major public health problem that constitutes a significant share of the global burden of disease. Previous studies conducted in this area indicated the importance of such epidemiological studies. The most critical impact of these studies is their effect on changing current regulations and, therefore, decreasing poisoning cases. We aimed to evaluate all poisoning cases with regard to the patients' demographics and the involved intoxicants. Methods: The present study was conducted to investigate all poisoning cases who were admitted during a three-year period. Causes of poisoning, hospitalization, management procedures and outcome of the cases were surveyed. A total of 1448 patients referred to Shahid Beheshti Hospital (Babol, Iran) from 2015 to 2018. Results: More than half of the patients were females (51.7%), and the majority of poisoning cases were seen in patients aged between 15 to 25 years (34.2%). It was found that suicide made a large part of poisoning cases (65.6%), and females tend to attempt suicide more than males (64.3% vs. 35.7%, respectively). Also, regular drugs followed by club drugs were the most abundant toxic agents (52.1% and 23.3%, respectively). Aluminum phosphide (AlP) was the most lethal intoxicant in our study, accounting for 68.2% of all deaths. Conclusion: According to the results, it is concluded that the existing regulations for drug control and suicide prevention have not been efficient enough and further actions yet to be made to reduce the consequences of drug- and non-drug-related toxicities. [ABSTRACT FROM AUTHOR]

Aluminum phosphide (ALP) is used extensively for burrowing mammal control. However, recent changes have been made to the ALP label which could substantially limit its utility for burrowing mammal control in the future. As such, I developed surveys to help quantify the impact that these changes are likely to have on ALP usage and vertebrate Integrated Pest Management in California. These survey findings were compared to information gathered from the California Department of Pesticide Regulation’s Pesticide Use Report for 2010 to relate the survey findings to the broader spectrum of users throughout California. I found that 49,005 lbs of active ingredient (AI) of ALP was used for burrowing mammal control in 2010, with most applications occurring in residential areas, applied primarily by licensed Pest Control Operators who specialize in vertebrate IPM. Most applications were applied to control pocket gophers, while ground squirrel and mole burrow systems were also treated. Collectively, new buffer and posting restrictions resulted in expected losses of 70% and 26% of agricultural applications of ALP for pocket gophers and ground squirrels, respectively. The impact of restrictions in residential areas may be even more extreme, with estimated reductions in ALP applications ranging from 70-98%. Alternative control methods were typically considered less efficacious than ALP. Furthermore, 13-34% of respondents indicated that they would no longer control these pests in areas where they could not use ALP. Insufficient or ineffective management programs targeted at these pests could result in increased economic damage, greater human health and safety concerns, and increased environmental degradation. Even though ALP has a safe track record in California, ALP users were willing to obtain greater training on its safe use while adhering to a 67% increase in the previous 15-foot buffer restriction, if it meant relaxing some of the current restrictions. Because of the extreme importance of burrowing mammal control, combined with the high efficacy and safe track record of ALP, perhaps these or alternative mitigation steps should be considered to ensure the safe and effective use of ALP. Otherwise, it is quite possible that the estimated 85% reduction in future ALP applications for burrowing mammal control could result in far greater negative consequences than the benefits gained from the new regulations.

Rodenticides are often used to control burrowing rodents but have not been overly efficacious for Belding’s ground squirrels due to poor bait acceptance. This has left alfalfa growers searching for alternative options for controlling this rodent species. As such, we tested aluminum phosphide and gas cartridge burrow fumigation in an alfalfa field in Butte Valley, CA, to determine if either of these approaches were efficacious and cost effective for controlling Belding’s ground squirrels. A comparison of the number of burrows treated and the number of burrows reopened 48-hours post-treatment indicated that both burrow fumigants were highly effective (aluminum phosphide = 94-98%, gas cartridges = 100%). The average cost per application was $1.05 and $2.92 for aluminum phosphide and gas cartridges, respectively. Given the almost 3-fold difference in cost of application between the two approaches, aluminum phosphide appears to be the more practical approach for Belding’s ground squirrel control. Although we currently lack an approach for estimating the amount of damage that Belding’s ground squirrels are likely to cause to an alfalfa field, it seems plausible that burrow fumigation could be a cost effective approach to reduce damage caused by this species, particularly if long-term control can be obtained. Possible long-term management options for Belding’s ground squirrels are discussed.

Aluminum Phosphide (ALP) poisoning is regarded as fatal; however, it is commonly used in developing countries. In some countries, such as India and Iran, it is still being used to protect grain against pests at home. As yet, no known antidote is reported to be effective against ALP poisoning. ALP acts through blockage of cell respiration, alteration of cell permeability, and induction of oxidative stress. Some factors can worsen the prognosis of its intoxication, which include hyperglycemia on admission, ingestion of fresh tablets, cardiac abnormality, especially Ventricular Tachycardia (VT), severe metabolic acidosis, cardiogenic shock and other types of shocks, electrolyte disturbances, end-organ damage, and a need for mechanical ventilation. ALP kills its victims by induction of multi-organ failure. In this study, we controlled the patient’s VT using MgSO4, electric shock, amiodarone, and lidocaine. We also encountered the cardiogenic shock using norepinephrine, High-Dose Insulin (HDI), antioxidants, sodium bicarbonate, and normal saline. Moreover, myocardial ischemia, recurrent VTs, and adverse cardiac effects were protected via tight control of magnesium and other electrolytes.

Background: Rice pill poisoning is among the most frequent causes of death among poisoners. Despite advances in the treatment of this poisoning, its mortality rate remains high. The symptoms of Aluminum Phosphide (AlP) poisoning are varied and progressive. One of the essential foundations of diagnosis is based on the history of swallowing the pill by the patient or their companions. Case Report: A 20-year-old woman with generalized abdominal pain and a diagnosis of peritonitis was operated. The operative finding was total gastric necrosis. After the operation, the patient’s husband claimed that she had consumed some rice pills, intending to commit suicide. Despite all efforts, she remained in persistent septic shock and multi-organ failure and passed away after surgery. Conclusion: Total gastric necrosis could be among the lethal complications of rice tablet (AlP) poisoning.

Aluminum phosphide (AlP) is a commonly used cheap rodenticide, insecticide, and fumigant. Most intoxications in the literature are suicidal ingestions, however, AlP may cause incidental inhalational toxicities as well. After ingestion or inhalation, nausea, vomiting, dyspnea and abdominal pain develops within minutes. Hallmark of toxicity is refractory hypotension, cardiac failure and severe metabolic acidosis developing within a matter of hours are the major cause of mortality. In Turkey, AlP tablets are widely accessible and are sold without any restrictions. However, there are few local case reports in the literature. Additionally, incidental AlP intoxications are rarely reported.

Background: Aluminium phosphide (ALP) is a highly effective insecticide and rodenticide used frequently to protect stored grain. Acute poisoning with this compound is common in some countries including India and Iran, and is a serious health problem. The objective of this study was to survey ALP poisoning and the outcome in hospitals in Karaj, Iran. Materials and Methods: The study was a retrospective study from April 2006 to April 2011. Records of all patients admitted and hospitalized to hospital during the five-year period were collected. Information including gender, age, amount of ALP consumed, route of exposure and outcome were extracted from the patients notes. Results: During the five-year period, 67 patients, 53.7% men and 46.3% women were admitted with ALP poisoning. Most poisoned people were under the age of 21 years.The most common signs and symptoms at admission were nausea (79.4%), vomiting (76.5%), abdominal pain (31.4%) and metabolic acidosis (41.1%). Suicidal intention was the most common cause of poisoning leading to 44.8% deaths and most cases were male (P

This paper reports the case of collective acute phosphide (PH 3 ) intoxication among the crew aboard a merchant ship. All the intoxicated individuals were hospitalized 3 months after the accident. The aim of examinations was to identify late health effects of the accident. Laboratory tests and consultations were performed during their stay in the hospital. There were 5 cases of toxic liver damage. other 5 patients were diagnosed with posttraumatic stress disorder and adjustment disorders. The results of the study suggest that in cases of acute phosphide intoxication, the assessment of patients’ psychological functioning should be an indispensable part of diagnostic procedure. Med Pr 2018;69(3):337–344

Background & Objective: Poisonings are of the major public health challenges. Non-medicinal poisonings are of the most common types and causes of referring to medical centers worldwide. The present study was aimed to determine the non-medicinal poisonings pattern in adults of Gorgan city. Methods: The present cross-sectional study was conducted on all non-medicinal poisoned patients referred to the 5Azar hospital from 2008 – 2015. Data were collected on checklists using census data collection method and were analyzed by Stata 11.0 software using Pearson’s Chi- square test. Results: Of all 800 admitted poisoning cases, 227 individuals were non-medicinal and mostly male (72.7%). The ages of 34.4 % of cases were between 20 and 29 years. Moreover, 68.7% of all cases were living in urban areas, 57.7% were married and 27.8% were educated up to high school. Poisonings mostly occurred during summer (30%) and intentional (suicidal) poisonings were known as the major form (47.1%). Opium and aluminum phosphide were the most important poisoning agents (54.2%). Finally, 29 patients (12.8%) had passed away where aluminum phosphide poisoning was the main reason (55.2%). Conclusion: Intentional poisonings by opium and aluminum phosphide were identified as the main causes of non-medicinal poisonings. It is necessary to emphasize on educational programs, prevention methods and general awareness.

Fumigation with either gas cartridges or aluminum phosphide is often considered to be an effective method for controlling California ground squirrel populations, although few studies have corroborated their effectiveness. Additionally, utilizing aluminum phosphide in combination with gas cartridges could increase effectiveness of both fumigants by indicating additional burrow openings through escaping smoke from gas cartridges and allowing for treatment of these additional openings with aluminum phosphide, which is a cheaper and potentially more effective material. Therefore, we compared the efficacy of gas cartridges, aluminum phosphide, and a combined treatment on ground squirrel populations from mid-April through early May 2009 to determine which was most effective. We established 4 plots (3 treatments plus control) at each of 2 treatment sites in Madera County, California. All plots were between 1 and 2 ha in size with survey areas of 0.3 - 0.5 ha centrally located within the plot. Ground squirrels were visually counted within survey areas for 3 consecutive days prior to treatment. Following counting, treatments were applied. Forty-eight hours post-treatment, squirrels were again counted within survey areas to determine percent control. These counts were repeated the following 2 days. All treatments were then reapplied for the same plots, with similar surveys again following 48 hours post-treatment. We found that all fumigation methods resulted in marginal to exceptional control of ground squirrels (percent control: gas cartridges = 62 - 86%, aluminum phosphide = 97 - 100%, gas cartridges + aluminum phosphide = 59 - 71%). We suggest aluminum phosphide use could be expanded to increase ground squirrel control in California, given its high efficacy combined with its relatively cheap material cost.

Aluminium phosphide (AlP) is a common fumigant used for controlling rodents and pests in grain storage facilities. Its consumption is reported in accidental or suicidal cases carrying high mortality. In the present case, a young male was reported with ingestion of AlP with severe lactic acidosis and systolic dysfunction. The patient was managed with extracorporeal membrane oxygenation. In reserved cases, ECMO can be instituted taking in view of risk and complications. [ABSTRACT FROM AUTHOR]

This study provides details of the electronic and optical structures and binding energies of sarin (SF) and chlorosarin (SC) with Al–N and Al–P surfaces of Al12N12 and Al12P12 nanoclusters in the gas phase. The adsorption mechanism of SF and SC on these nanoclusters containing the Al3+ central cation was studied. Optimized geometries and thermodynamic parameters of SF and SC adsorption complexes were calculated. SF and SC are chemisorbed on these nanoclusters because of the formation of PO···Al bonds. The chemical bond is formed between an oxygen atom of SF and SC and an aluminum atom of fullerene‐likes (chemisorption). However, the binding energies of the complexes with the Al12N12 nanocluster are larger than these values for the Al12P12 nanocluster. The interaction enthalpy and Gibbs free energy of all studied systems were found to be negative. We can conclude that SF and SC will be adsorbed preferably on Al12N12 nanocluster. [ABSTRACT FROM AUTHOR]

Introduction: Acute aluminum phosphide poisoning is common in low- and middle-income countries, and is associated with very high case fatality. The addition of glucose-insulin-potassium (GIK) infusion to the standard supportive care has been proposed to improve outcomes. We aimed to assess the effectiveness of GIK infusion in acute aluminum phosphide toxicity. Methods: We performed a prospective open-label pilot study in a tertiary care hospital in north India in patients over 13 years of age with acute aluminum phosphide poisoning, to determine whether the treatment with GIK infusion improved outcomes. The primary outcome was in-hospital case fatality, and the secondary outcomes were the duration of hospital stay, the requirement of mechanical ventilation, and the change in hemodynamic and metabolic parameters. Results: A total of 60 patients were randomly assigned to groups that received either GIK infusion with supportive care or supportive care alone. Baseline parameters in both groups were comparable. Treatment with GIK infusion was associated with significantly lower in-hospital case fatality compared with supportive care alone (46.7% versus 73.3%; p-value 0.03). It was associated with a longer duration of hospital stay (p-value < 0.01) and reduced requirement of mechanical ventilation (p-value < 0.01). The treatment improved blood pressure (systolic, diastolic, and mean arterial pressure) and Glasgow coma scale score at various time intervals; however, pulse rate and metabolic acidosis (blood pH and bicarbonate levels) remained comparable in both the groups. Hyperglycemia was significantly higher in the GIK group but was easily managed. Conclusion: Treatment with GIK infusion may improve survival and hemodynamics in patients with acute aluminum phosphide poisoning. [ABSTRACT FROM AUTHOR]

Introduction: Aluminum phosphide (ALP) is one of the most common causes of poisoning. Also, it is commonly used to attempt suicide. Extracorporeal Membrane Oxygenation (ECMO) is a therapeutic method that supports the function of the heart and lungs, giving body enough time for detoxification and organ function improvement; therefore, management of the problem using ECMO is critical in these patients and increases the survival chance. Moreover, the impact of COVID-19 on the treatment course during the COVID-19 pandemic and the patients' involvement and contact with the virus is a critical issue with unknown consequences. Case presentation: The patient was an 18-year-old girl who was hospitalized due to the poisoning aluminum phosphate. The ECMO was connected to the patient during CPR. Then, the patient was transported to a specialized healthcare facility. At the time of arrival, the EF (Ejection Fraction) was less than 5%. During the course of poisoning, the patient developed ARDS, fulminant hepatitis, massive gastrointestinal and vaginal bleeding, and septicemia. The ECMO was weaned on day 5 when the EF was reported 55%. In the following, the general and pulmonary conditions of the patient exacerbated when she was suspected of having COVID-19. The necessary therapeutic measures were done and finally, the patient was discharged after 45 days. Conclusion: ECMO is a useful therapeutic procedure in ALP poisoned patients. In case of careful management, it can be used in multiple organ involvement and prolonged PCR. Considering the COVID-19 pandemic, it is very important to notice the chance of COVID-19 infection in ICU during treatment. [ABSTRACT FROM AUTHOR]

Nowadays, poisoning with metal phosphides, especially aluminum phosphide (ALP), is one of the main health threats in human societies. Patients suffer from significant complications due to this type of poisoning, and the heart is one of the main organs targeted by ALP. Therefore, in this study, we discussed the effect of phosphine on cardiac function. This study is based on data obtained from PubMed, between 2002 and 2020. The key keywords included "Aluminum phosphide," "Oxidative Stress," "Mitochondria," "Cardiovascular disease," and "Treatment." The results showed that ALP produced reactive oxygen species (ROS) due to mitochondrial dysfunction. ROS production leads to red blood cell hemolysis, decreased ATP production, and induction of apoptosis in cardiomyocytes, which eventually results in cardiovascular disease. Since ALP has the most significant effect on cardiomyocytes, the use of appropriate treatment strategies to restore cell function can increase patients' survival. [ABSTRACT FROM AUTHOR]

Apart from the anticancer, antioxidant, anti‐inflammatory effects, and inhibition of aromatase, chrysin is involved in the protection of cardiovascular disorders. Cardiovascular complications are the main cause of death induced by aluminum phosphide (AlP) which is related to oxidative stress and mitochondrial damages. For this purpose, we investigated the effect of chrysin as an antioxidant and mitochondrial protective agent against AlP‐induced toxicity in isolated cardiomyocytes and mitochondria obtained from rat heart ventricular. Using by biochemical and flow cytometry, cell viability, reactive oxygen species (ROS) formation, mitochondria membrane potential (MMP), lysosomal membrane integrity, malondialdehyde (MDA) content, and glutathione (GSH) and oxidized glutathione (GSSG) content were measured in isolated cardiomyocytes. Also, mitochondrial toxicity parameters such as mitochondrial NADH/succinate dehydrogenase activity, mitochondrial swelling, ROS formation, MMP collapse, and lipid peroxidation were analyzed in isolated mitochondria. Our results showed that the administration of chrysin (up to 10 μM) efficiently decreased (P < 0.05) cytotoxicity, oxidative, lysosomal, and mitochondrial damages induced by AlP, in isolated cardiomyocytes. Also, our finding in isolated mitochondria showed that chrysin (up to 10 μM) significantly (P < 0.05) decreased AlP‐induced mitochondrial toxicity. These findings demonstrated that chrysin as an antioxidant and mitochondrial protective agent exert protective effect in wild‐type cardiomyocyte treated with AlP. It was concluded that chrysin significantly reduced the toxicity of AlP in isolated cardiomyocytes and mitochondria. Due to the very low toxicity of chrysin for humans, it could be a promising agent in treatment of AlP poisoning. [ABSTRACT FROM AUTHOR]

Despite improved yield in the field, wheat (Triticum aestivum L.) at storage is heavily attacked by numerous pests. The loss assessment studies carried on wheat in 2014 and 2015 revealed that household storage practice suffered highest grain damage and weight loss due to storage pests. Healthy grains were highest in treated samples over untreated control samples at all storage locations. Highest pest incidence was observed in treated household samples over PAU and Moga outdoor storage, whereas there was no incidence found in Moga indoor storage. The population build up of Rhyzopertha dominica was highest in untreated control followed by T. castaneum, S. oryzae and C. cephalonica. Among various storage protection strategies used at storage levels, Moga (outdoor) storage registered a highest use of aluminium phosphide as fumigation practice followed by Rampuraphul (indoor), household storage, Moga (indoor) and PAU practice. At the end of investigation period, farmers and Food Corporation of India (FCI) were advised to follow PAU practice. [ABSTRACT FROM AUTHOR]

Intoxication and drug overdose as suicidal attempt are rare in pregnancy. We report here the case of aluminum phosphide poisoning in a pregnant lady through oral and intravaginal administration which was managed with aggressive supportive measures without resorting to extracorporeal life support. [ABSTRACT FROM AUTHOR]

Introduction: Aluminum phosphide (AlP) ingestion for self-harm is associated with a high case-fatality rate (CFR) in low- and middle-income countries. A reliable and accurate prognostic scoring tool is required for appropriate triaging, to guide clinical decision-making, and to evaluate the efficacy of therapeutic interventions for the patients with AlP toxicity. Materials and methods: We performed a prospective cohort study in a tertiary care hospital in north India in patients aged 15 years and over with acute AlP poisoning, investigating the parameters associated with CFR, and developing a reliable and simple prediction score. Results: The CFR was 51% in this cohort of 105 patients. Three parameters--pH <7.25, score on Glasgow coma scale (GCS) <13, and systolic blood pressure (SBP) <87 mm Hg were most robust predictors of CFR (odds ratio; 12.614, 18.621, and 17.600, respectively; area under the receiver operating characteristic curve--0.808, 0.796, and 0.776, respectively). Based on these parameters (with 1 point to each), a prognostic score was developed, ranging from 0 to 3 points. A total score of 3 had a 98.2% specificity and a positive predictive value of 96.4%, whereas a score ≤1 had a 100% sensitivity and 100% negative predictive value. Conclusion: A scoring system based on low pH (P), low GCS score (G), and impaired or low SBP (I) ("PGI" score) may provide a simplified predictive model for mortality in AlP poisoning. [ABSTRACT FROM AUTHOR]

Introduction: Aluminum phosphide poisoning (ALP) has a high-mortality rate despite intensive care management, primarily because it causes severe myocardial depression. This case report highlights the subset of ALP patients presenting as ST elevation myocardial infarction (STEMI) with profound myocardial dysfunction and multiorgan failure and successfully treated with extracorporeal membrane oxygenation (ECMO), trimetazidine, and magnesium. Case description: A 25-year-old man without any comorbidities was brought to emergency department with dyspnea and hypotension. His electrocardiograph (ECG) revealed STEMI with elevated troponin levels, arterial blood gas (ABG) showed severe metabolic acidosis, and echocardiography (echo) revealed ejection fraction 15%. He was initiated on venoarterial (VA) ECMO in view of refractory hypotension. History of consumption of three tabs of celphos was revealed later by the family members. He progressed to cardiogenic shock, arrhythmias, respiratory failure, acute kidney injury with severe lactic acidosis, liver injury, pancreatitis, and disseminated intravascular coagulation (DIC). He was successfully supported by ECMO, hemodialysis, magnesium, trimetazidine, N-acetyl cysteine, inotropes, and blood products. He was weaned off ECMO on day 6 and was discharged home on day 12. Despite his severe and confounding clinical presentation, he had complete normalization of end-organ dysfunction with no neurological sequela. This case demonstrates the high index of suspicion required for ALP, given the potential for rapid progression and severe multiorgan toxicity. This report also highlights the importance of early referral to a tertiary care center with ECMO capability and also the role of magnesium and trimetazidine to suppress arrhythmias. Conclusion: Aluminum phosphide poisoning can present as STEMI with cardiogenic shock resulting in acute kidney injury, liver injury, pancreatitis, and DIC. Venoarterial ECMO provides an effective means of support until the recovery of organ function. Trimetazidine and magnesium are helpful in suppressing fatal arrhythmias. This report emphasizes that early recognition and early institution of ECMO can save many young lives who succumb to toxic effects of this poison. [ABSTRACT FROM AUTHOR]

Rice tablet, also known as aluminum phosphide (ALP), is a nonorganic material used as an insecticide and rodenticide in the storage and transportation of grains. Phosphine gas, released from the chemical material, in contact with humidity and weak acid, can induce poisoning and death. This study was conducted to investigate the effect of ethanol extract of Echinophora cinerea leaves on ALP poisoning in heart in rats. In this study, factors such as blood pressure, heart rate, electrocardiography, and biochemical biomarkers of oxidative stress of cardiac tissue were evaluated. The use of Echinophora extract at a dose of 200 mg per/kg primarily improved bradycardia, hypotension, and cardiac conduction. Echinophora extract at a dose of 400 mg could protect body against oxidative stress. It seems that Echinophora extract has significant clinical positive effects that can be employed in treatment protocols of acute poisoning associated with ALP. Practical applications: Administration of the Echinophora cinerea extract can improve bradycardia, hypotension, and conduction disturbances of the heart caused by poisoning with rice tablet. E. cinerea extract also can increase the levels of antioxidant enzymes and protect the body against oxidative damage caused by poisoning with rice tablet. Therefore, Echinophora extract has significant clinical positive effects that can be used in treatment protocols of acute poisoning associated with aluminum phosphide. [ABSTRACT FROM AUTHOR]

Objective: To study the pattern of poisoning in Visakhapatnam and its demographic correlates. Materials & method: The study was retrospectively conducted in all poisoning cases admitted in Casualty department of Anil Neerukonda Hospital, Visakhapatnam and carried out during the period of 1st Jan 2014 to 31st Dec 2017. Results: Majority (47.37%) of the subjects were between the ages of 20-29years with slight preponderance towards female (52.63%) as compared to male (47.37%). Most of the cases belonged to lower socioeconomic status (94.74%). Place of occurrence was most commonly within the house (85.97%) & it was predominantly observed during winter season. Aluminum phosphide (21.05%) was the most commonly abused substance followed by Organophosphate compounds (14.04%). Conclusion: The government should take legislative steps to curb down the menace of poison in the hands of the vulnerable people in the society primarily focusing on developing the poisons with less toxicity or non-toxic to humans. [ABSTRACT FROM AUTHOR]

Aluminum phosphide (AlP) poisoning had high morbidities and mortalities with absence of a standardized approach for the treatment. The present study investigated the efficiency of GIT decontamination methods and Coenzyme Q10(Co Q10) (Ubiquinone) in improving the outcome of acute AlP poisoning. A total of 90 patients were included and all patients received immediately supportive measures, then they distributed into three equal groups: In group I, gastric lavage was done using KMNO4 solution (1:10 000); group II received 250-500 ml liquid paraffin oil orally; group III received 300 mg of Co Q10 dissolved in liquid paraffin. Co Q10 was continued in a dose of 200 mg/day every 12 h. Follow-up blood pressure, arterial blood gases, serum troponin level and need for intubation revealed that the best improvement was in group III followed by group II. The percentage of survivors was 76.67% in group III and 70% of the patients had no residual effects. In group II, the survivors were 63.33%, and 36.67% of the cases discharged without sequelae. The survivors in group I constituted 26.67% and only 16.67% of the patients had no residual effects. GIT decontamination with aqueous solutions in acute AlP poisoning should be avoided. Rapid oral intake of any available oil as a prehospital treatment or immediately on hospital admission could critically improve the outcome of acute AlP poisoning. Besides, the addition of Co Q10 to the oil further improve patients' prognosis. [ABSTRACT FROM AUTHOR]

Background and Aims: Poisoning is most common method of committing suicide in India. Objectives of this study to assess prevalence of suicidal poisoning among all poisoning cases, its socio-demographic profile and its reasons in all admitted cases of suicidal poisoning in hospital. Methods: A cross-sectional study was conducted on cases of poisoning of any age group admitted in the Chhatrapati Shivaji Subharti Hospital, Meerut. Poisoning cases with history or evidence of suicide were further interviewed. A semi-structured interview schedule in Hindi was used to collect data. Microsoft Excel 365 and R software version 3.6.0 were used for data entry and analysis respectively. Results: Among total 135 poisoning cases admitted in hospital, 126 provided consent and included in the study. Prevalence of suicidal poisoning was 77.7% (98). Most common age group involved was 11-20 years (36.7%) and 21-30 years (35.7%) and most of the participants were males (59.2%). Most suicidal poisoning cases took Aluminum Phosphide (31.6%), followed by Organophosphates (20.4%) as poison. Most frequent reasons for suicide as described by participants were 'Family quarrel or family unhappiness' (29.6%), 'failure in examination or interview or business' (23.5%), 'ill treatment by spouse or in laws' (16.3%) and 'unemployment' (9.2%). Conclusion: Our study shows that consuming Agriculture poisons (Aluminum Phosphide and Organophosphates) are most common (52%) poisons consumed by suicidal poisoning cases. Agriculture poisons (Aluminum Phosphide and Organophosphates) are easily available in markets in India. There should be some restriction on their purchase to reduce suicidal incidences. [ABSTRACT FROM AUTHOR]

Objective(s): Aluminum phosphide (AlP) is commonly used pesticide which could cause poisoning mainly through the induction of oxidative stress. The present study aimed to evaluate the effects of nano-curcumin and curcumin on the oxidant and antioxidant system in the liver mitochondria using AIP-induced toxicity model. Materials and Methods: In this study, 36 male albino Wistar rats were randomly divided into six groups (n=6). The control subjects and animals poisoned with AlP (2 mg/kg) received treatment with and without nano-curcumin (100 mg/kg) and curcumin (100 mg/kg) for seven days. Mitochondria were isolated from the liver and analyzed in terms of lipid peroxidation (LPO), total antioxidant capacity (TAC), total thiol groups (TTGs), superoxide dismutase (SOD), and catalase activity. In addition, mitochondrial viability was assessed. Results: AlP caused a significant increase in the LPO levels, while significantly decreasing TAC, TTG, SOD, catalase activity, and mitochondrial viability compared to the controls (P<0.05). Moreover, nano-curcumin treatment significantly enhanced TAC, TTG, SOD, and mitochondrial viability (P<0.05). Curcumin could also improve TTG and mitochondrial viability (P<0.05). Conclusion: According to the results, nano-curcumin exerted protective effects against AlP-induced experimental toxicity, and the effect was attributed to the antioxidant properties of this compound. [ABSTRACT FROM AUTHOR]

An analysis of the atomic polarizabilities α in stoichiometric aluminum phosphide clusters, computed at the MP2 and density functional theory (DFT) levels, the latter using the B3LYP functional, and partitioned using the classic and iterative versions of the Hirshfeld method, is presented. Two sets of clusters are examined: the ground-state AlnPn clusters (n=2-9) and the prolate clusters (Al2P2)N and (Al3P3)N (N≤6). In the ground-state clusters, the mean polarizability per atom, i.e., α/2n, decreases with the cluster size but shows peaks at n=5 and at n=7. We demonstrate that these peaks can be explained by a large polarizability of the Al atoms and by a low polarizability of the P atoms in Al5P5 and Al7P7 due to the presence of homopolar bonds in these clusters. We show indeed that the polarizability of an atom within an AlnPn cluster depends on the cluster size and the heteropolarity of the bonds it forms within the cluster, i.e., on the charges of the atoms. The polarizabilities of the fragments Al2P2 and Al3P3 in the prolate clusters were found to depend mainly on their location within the cluster. Finally, we show that the iterative Hirshfeld method is more suitable than the classic Hirshfeld method for describing the atomic polarizabilities and the atomic charges in clusters with heteropolar bonds, although both versions of the Hirshfeld method lead to similar conclusions. [ABSTRACT FROM AUTHOR]

Background: The suicide with aluminum phosphide, known as rice tablet, has increased significantly. This study aimed to investigate the epidemiology of Aluminum Phosphide (ALP) poisoning and determine the in-hospital mortality prognostic factors in adult people referring to ALP poisoning to one of the main poisoning centers in southern Iran. Methods: This retrospective cross-sectional study (March 21, 2014, to March 21, 2018) was conducted on all adult patients (>16 years) with ALP poisoning who were referred to Ali-Asghar Hospital (affiliated with Shiraz University of Medical Sciences). All data were extracted from the patients’ medical files. The patients were categorized into two groups of survived and non-survived. Univariate and multivariate logistic regression analyses were conducted to determine prognostic factors for in-hospital mortality, and Odds Ratios (ORs) were reported. Results: Totally, 97 patients were enrolled in this study. The patients’ Mean±SD age was 29.3±12.2 years. Both study groups (survived and non-survived) were matched in most demographic and poisoning characteristics. Nausea (62.9%) and vomiting (49.5%) were the most symptoms at the time of admission. Castor oil (66%), N-acetyl cysteine (56.7%), and magnesium sulfate (52.6%) were the most frequent treatment in these patients. The multivariate analysis showed that age (OR=1.12, 95%CI: 1.03-1.22), body temperature (OR=0.02, 95%CI: 0.01-0.48), resistant acidosis (OR=77.10, 95%CI: 5.05-1176.86), and taking sodium bicarbonate (OR=12.35, 95%CI: 1.25-122.10) were the prognostic factors of in-hospital mortality. Conclusion: The in-hospital mortality rate in patients with ALP poisoning was 29.9%. Age, illiteracy, body temperature, resistant acidosis, and taking sodium bicarbonate were the prognostic factors of in-hospital mortality in these patients.

Introduction: Rice tablet, also known as aluminum phosphide (ALP), is a nonorganic material used as an insecticide and rodenticide in storing and transporting grains. Phosphine gas, released from the chemical material, in contact with humidity and weak acid, can induce poisoning and death. Unfortunately, no effective antidote has been discovered to treat poisoning with rice tablet. This study was conducted to investigate the effect of ethanol extract of Echinophora cinerea leaves on ALP poisoning in the heart of rats. Methods and Materials: In this study, factors such as blood pressure, heart rate, electrocardiography and biochemical biomarkers of oxidative stress in rat heart tissues were investigated. Results: The use of Echinophora extract at a dose of 200 mg per/kg primarily improved bradycardia, hypotension, and cardiac conduction. Echinophora extracts at a dose of 400 mg could protect body against oxidative stress induced by aluminium phosphide intoxication. Conclusion: It seems that Echinophora extract has significant clinical positive effects that can be employed in treatment protocols of acute poisoning associated with ALP. [ABSTRACT FROM AUTHOR]