Phosphine Gas Poisoning in Children: A Case Series Study from Tertiary Health Care Center of Karachi, Pakistan

Dr. Abid Ali Jamali*, Dr. Emad-Uddin Siddiqui
Page No. 72-76

Phosphine poisoning is an uncommon but hazardous public health issue. It is widely used as chemical insecticide and pesticide domestically and exposure to this chemical, mostly accidental among children, may lead to fatal symptoms if not managed immediately. Previous studies have explored the mechanism of its deleterious effect. However, literature on presentation of phosphine poisoning is sparse. We observed a short case series form a family who was exposed to phosphine gas from aluminum phosphide tablets that were used for fumigation purpose in bedroom. Family locked the house for six hours only and then used that bedroom without proper cleaning and removal of the chemical from the house. No adequate aeration of the room before use was done. Detail history from parents was taken and clinical details were identified however further details were noted from their medical records. We identified three cases of phosphine poisoning during this exposure. One of the babies was brought dead, with history of acute onset nausea and vomiting followed by increasing paleness, sweating and questionable seizure episode along with loss of body posture and unresponsiveness. Other two girls presented with generalized weakness, nausea, vomiting and lethargy since morning. Both sisters were admitted to pediatric intensive care unit for less than one week and were managed symptomatically along with magnesium sulfate. The objective of this case series study is to bring in attention of the families, health care community and the stake holders for the need to replace harmful insecticide fumigation practices with the safer ones, as phosphine gas can cause late onset of clinical feature and sudden death, probably because of fatal myocarditis as observed by echocardiography in both survived girls. Whenever fumigation is done parents/family members be provided with proper written guidelines that along with fumigation process and reuse of the house must mention possible side effects. Moreover, to increase public awareness, proper labeling and precautions should be written on all commonly sold pesticides and the constituent of hazardous compounds they contain.