Abstract

TREATMENT REGIMEN FOR CELPHOS POISIONING

Hakim Ali Qanoon*, Rafiqa Eachkoti, Promila Phaughat

ABSTRACT

Celphos poisoning is a major cause of mortality largely due to nonavailability of its antidote, due to delay in appropriate management and skepticism amongst physicians regarding the outcome. Although different trials has been tried to counter its irreversible toxic effects but hardly with any concrete success. Here we report novel intervention, the protocol of which we have formulated and standardized for last 1.5years, for Celphos poisioning which aims to diminish the production and absorption of phosphine, enhance its excretion and prevent any organ toxicity with appropriate supportive therapy. The management plan involves gastric lavage with an aliquot of coconut oil mixed with NaHCO3 followed by KMNO4 in Normal saline as an essential step in the initial stage. In addition the plan involves appropriate supportive measures that were taken which include Inj. NS-4 units (500ml each) Iv. over 6hrs, inj. Citicholine 500mg Iv. BD (antioxidant to prevent neuronal toxicity), Tab.N-Acetyl cysteine (dispersable) 600mg 1 tab PO BD (antioxidant, replenishing cellular glutathione), broad spectrum antibiotics eg. Inj. Monocef 1gm Iv. BD and inj. Metronidazole 500mg Iv. TID, Magnesium (inj MgSO4 (50%)(4 ampules in 500ml of NS) as cell membrane stabilizer to prevent arrhythmias, dopamine for inotropic support, if required and inj. Pantop -40mg Iv. BD to decrease HCl production and for symptomatic relief. The survival rate of this novel intervention turns out to be 91%(10/11). Early arrival, history of vomiting, early diagnosis, resuscitation, decreasing formation and absorption of phosphine (by gastric and retrograde lavage with coconut oil followed by KMnO4), intensive monitoring and supportive therapy were associated with good outcome. We, therefore, recommend the use of this regimen /protocol by all the intensivists and physicians especially in rural and suburban areas in developing countries with limited resources like India where instruments like gastroscope to remove undissolved pellets, or intra-aortic balloon pump (IABP), ECMO (extracorporeal membrane oxygenation) as a supportive measures, to provide prompt and adequate cardiovascular support till toxin is removed, in health care divisions are hardly available.

Keywords: Celphos, gastric lavage.