الفهرس 
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Abstract
Aluminium phosphide (AlP), an inexpensive solid fumigant, is frequently used for grain conservation despite its alleged high toxicity, and it doesn’t affect seed viability. It is available as dark grey tablets weighing 3g, and it contains 56% AlP and 44% carbamate.
Moisture-exposed AlP undergoes a chemical reaction producing phosphine gas, which in turn induces cellular hypoxia by affecting the mitochondria.
This current study is a clinical prospective one that was conducted on 53 patients with acute aluminium phosphide poisoning. They were admitted to Minia Poison Control Center (MPCC) to assess the clinical picture, outcomes, and the role of magnesium sulfate as an antidote in such cases. Patients with any chronic illness or co-ingestion were excluded from the study.
All selected cases underwent the following:-
• A detailed history was taken, with special attention paid to the amount consumed and symptoms that appeared post-ingestion.
• A full examination was done, including blood pressure, GCS, and presence of cyanosis and numbness.
• Laboratory investigations were conducted, including ABG and serum magnesium levels.
• There were 32 patients manifested with AlP toxicity. They were randomly divided into two groups; 16 patients each. group A received magnesium sulfate infusion using a bolus protocol of administering 4 g intravenously, 2 g after 1 h, and then 1 g every 4 hours, in addition to other supportive therapy. group B only received supportive therapy but not magnesium sulfate.
• The outcome was determined according to the fate of the patient; either died or survived.
Sociodemographic study:
The age of the studied cases ranged from 1.5-45 years old; 58.5% females and 41.5% males. 30.2% of cases were students, 28.3% were housewives, 17% were workers, 9.4% were farmers, and non-working as well as children represented 7.5%. 88.7% of cases attempted suicide, 7.5% were exposed to it accidently, while 3.8% received it homicidally.
Clinical picture
There was an insignificant statistical difference between survivors and non-survivors regarding clinical presentation, except for numbness and cyanosis. 47.8% of non-survivors developed numbness while only 22.2% of non-survivors developed it. It couldn’t be assessed in 34.8% of non-survivors due to affection of their conscious level. Cyanosis appeared in 56.5% of non-survivors while in survivors it wasn’t detected.
Clinical examination
In survivors, systolic blood pressure was significantly higher than in non-survivors.
Also, diastolic blood pressure was significantly higher in the survivor group than in non-survivors.
Consciousness affection of the studied cases was divided into mild, moderate, and severe according to GCS. All survivors and 56.5% of non-survivors were mildly affected, while 21.7% of non-survivors were moderately affected, and the remaining 21.7% of non-survivors were severely affected.
Laboratory investigations
As regards the ABG parameters; PH, PCO2, HCO3, and PO2 in the studied cases, they were significantly higher in survivors than in non-survivors. The decrease in levels of PH, HCO3, PO2, and PCO2 was directly proportionate to the severity of clinical manifestations. Serum magnesium levels were significantly lower in the non-survivor group than in the survivor one.
Outcome
The absence of a specific antidote results in high mortality rates, which reached 72% in this study. As regards the survivor group, 77.8% of them received Mg sulfate during their management. In non-survivors, 60.9% of them didn’t receive Mg sulfate. However, there was an insignificant statistical difference between both groups. This might be secondary to the small sample of the studied cases.