Phosphine poisoning results from inhalation of fumigants, causing a severe intoxication reaction. In addition to magnesium phosphide and aluminum phosphide, phosphine (PH3) is mainly found in pesticides used to control pests.
What is phosphine poisoning?
Synonyms are phosphine poisoning and phosphorus poisoning. Other designations are monophosphine and phosphine. The main sources of poisoning are technically impure acetylene and ferrosilicon. In combination with moisture, both substances form phosphine and arsine, which irritate the lungs and act as a central neurotoxin. Through the inhalation process, phosphine forms in the body, which can lead to phosphine poisoning. See dictionaryforall for Testicular Dystopia in Dictionary.
PH3 develops in metabolism through magnesium phosphide or aluminum phosphide, blocking important fermenting systems in the body. A high concentration of PH3 leads to metahemoglobin formation of up to thirty percent. In small doses, the body breaks down the unwanted toxin via phosphoric acid or phosphate.
Causes
Phosphine is a severe metabolic toxin with inhibition of vital cell enzymes. Poisoning occurs through inhalation. Symptoms of poisoning occur repeatedly, especially with improper use of pesticides or acetylene substances containing PH3. Phosphoric acid residues can also be found in plasticizers, paints, varnishes, solvents, ordnance and plastics.
Some employees also come into contact with phosphine through the performance of their professional activities. However, phosphine poisoning occurs regularly through improper use of the hazardous substances. Another cause can be poisoned groundwater due to improper disposal of pollutants by companies.
In Germany, phosphine is used as a fumigant to kill storage pests in containers and storerooms and to treat dry foods such as spices, coffee, cocoa, oilseeds, dried fruit and stored cereals. For organic farming, the use of PH3 is not allowed. Therefore, conventionally produced foods may contain small amounts of phosphine residues. To date, no acute or secondary poisoning has occurred as a result of the consumption of foodstuffs contaminated with phosphine residues.
The dose contained in the contaminated food is too low to have a lethal effect. Chronic diseases that can be clearly traced back to phosphine residues have also not been detected to date. Chronic poisoning from long-term exposure is not known because the small doses that people may ingest from their environment are too small to cause acute symptoms of poisoning. These small amounts are excreted by the organism after some time.
There are different phosphorus substances: red, is considered to be relatively non-toxic, black, also not very toxic, white, lethal dose from 0.05 grams of poison absorption through the skin. The substance is colourless, but not odourless. It gives off an extremely unpleasant odor reminiscent of rotten meat, garlic and carbide.
Symptoms, Ailments & Signs
The intoxication symptoms are divided into acute and subacute intoxications. If a patient suffers from acute symptoms of poisoning from phosphine, this can immediately lead to death. These severe side effects lead to death within 24 to 48 hours due to asphyxia and pulmonary edema, accompanied by respiratory arrest and maximally dilated pupils. The symptoms of subacute poisoning are often not immediately recognizable.
Symptoms of the gastrointestinal tract such as nausea, vomiting and diarrhea are often the focus. Other symptoms of poisoning affect the central nervous system with exhaustion, headaches and abdominal pain, fainting, ringing in the ears, dizziness, sweating and numbness.
But also disorders of consciousness, unsteady gait and states of excitement can occur. Sometimes cyanosis, cardiac insufficiency, tachycardia, extreme shortness of breath with difficult inspiration (inhalation phase), feeling of pressure and burning pain behind the breastbone, in the diaphragm region and in the back are found. Fumigants primarily have a lasting effect on the respiratory system.
Metabolism is secondarily affected by exposure to phosphine with adverse effects on the brain, kidneys and liver. 0.01 mg/liter of air is lethal for the human organism if exposed to it for six hours. Amounts of phosphine that are harmless per se can have a more cumulative effect when inhaled repeatedly.
Diagnosis & course of disease
The complete picture of intoxication is not characteristic at first, but occurs in many forms. Phosphine poisoning is often confused with food poisoning because the side effects are similar. The autopsy findings are uncharacteristic. There are patients who do not show any pathological-anatomical symptoms.
Cardiac dilatation, pulmonary edema, congestion in the liver and kidneys are the main signs of PH3 intoxication. The blood is more fluid than normal and very dark. Apart from hyperemia of the lungs, kidneys, brain and trachea, minor hemorrhages in the myocardium only occasionally occur. The kidneys show clouded swelling of the renal tubules. The clinical findings of phosphorus poisoning and phosphine poisoning are congruent.
Complications
Poisoning with phosphine often has dramatic consequences. However, it depends on how high the concentration of the poison is, which the body comes into contact with. Phosphine can be absorbed through the skin or the respiratory tract. If a higher concentration than 0.05 grams of phosphine gets into the organism, the poisoning is always fatal after a six-hour exposure. But even at lower concentrations, life-threatening complications can occur.
Acute poisoning is characterized by respiratory paralysis and severe damage to the kidneys, liver and lungs. Pulmonary edema can develop, which then leads to respiratory arrest with a fatal outcome. Other signs of intoxication affect the central nervous system. Cardiac arrhythmias, shortness of breath, increased heart rate and disturbances of consciousness up to coma can occur.
Acute phosphine poisoning is always a highly life-threatening complication. However, phosphine poisoning can also occur subacutely. In these cases, the body is only confronted with low concentrations of the poison. But with frequent contact with low concentrations of phosphine, the toxic effect accumulates.
Eventually, severe damage to the brain, liver, and kidneys can occur, leading to long-term health problems. Furthermore, chronic phosphine poisoning often leads to pulmonary edema with severe breathing difficulties and cardiac insufficiency, which can also lead to fatal complications.
When should you go to the doctor?
If the affected person notices sudden irregularities inside the body due to the inhalation of gases or other environmental influences, this is an alarming sign. Medical help is required in the event of dizziness, discomfort or internal weakness. If there is a loss of consciousness, an emergency service must be alerted. If not breathing, bystanders should provide first aid if they can. Unsteady gait, numbness, coughing, and interruptions in breathing need to be presented to a doctor.
Sweating, hot flashes, tachycardia and a feeling of pain in the body must be examined by a doctor. Headaches, nausea and vomiting are further signs of a health impairment that should be clarified. Burning pain, dilated pupils, and struggling for oxygen are worrisome. If the affected person was exposed to chemical poisons or substances, attention should be paid to adequate fresh air and ventilation immediately. When staying in the building, the windows and doors must be opened. Without immediate adequate medical care, the person concerned is at risk of dying.
Balance disorders, a loss of the usual muscle strength and hearing disorders are alarm signals from the organism. A doctor is needed so that treatment can be started. Since the concentration of the poison is decisive for the further course of phosphine poisoning, the person concerned must be removed from the danger zone as quickly as possible.
Treatment & Therapy
Patients who show clear, but also less clear symptoms of PH3 poisoning must be referred immediately to the medical emergency service, which will ensure vital functions and initiate immediate decontamination measures. Before admission to a hospital, people at the scene initiate first aid measures. You must make the patient vomit and give him plenty of fluids immediately.
The first responders must ensure that they do not come into contact with the excrement, since phosphine is also absorbed through the skin. Soaked clothing must be removed immediately. If the eyes are affected, rinse them with plenty of water. In the emergency room, doctors flush the patient’s skin and/or eyes with a 3% or 5% sodium bicarbonate solution and chloramine T, respectively. After carrying out all emergency measures, the patient needs warmth, rest and darkness. In addition, he is ventilated.
Outlook & Forecast
The prognosis after phosphine poisoning depends on the level of exposure to the poison. It is a toxic fumigant used to protect shelf-stable food. Because of its high level of toxicity, this fumigant should only be used by properly trained professionals. However, there are often fumigation residues in sea containers.
Poisoning with phosphine can occur through inhalation – for example when gassing a sea container – or through contamination of the skin. Inhalational phosphine poisoning must be treated immediately as an emergency. Typical symptoms of poisoning can occur as a result of phosphine poisoning. With larger amounts inhaled or prolonged exposure, the organism can no longer excrete the ingested toxin on its own.
If the subsequent symptoms of poisoning, such as vomiting after nausea, sudden drowsiness and convulsions, are not treated immediately in intensive care, the poisoning victim may die in the worst case. The body can apparently break down minor exposures to residues on the fumigated fruit and vegetables on its own. In this case, the prognosis is significantly better without getting any permanent damage.
In Germany, only a few preparations with a certain phosphine content are permitted for the fumigation of conventionally produced food. These fumigation preparations may be used, for example, for deliveries of coffee or cocoa, dried fruit or seeds containing fat, legumes and larger grain deliveries.
Prevention
Phosphine may only be used by trained personnel, as it is highly toxic in its pure state, as well as being corrosive, harmful to the environment and highly flammable. Spontaneous ignition can occur in connection with oxygen. The safety regulations must be observed. Prevention in the clinical sense is not possible, only proper handling is indicated.
Aftercare
Phosphine poisoning sometimes causes damage to body organs. The lungs, liver or kidneys are often affected. This results in other diseases that require treatment. The follow-up care is then a suitable support in everyday life. At the end of the hospital stay, the patient is usually referred to a resident doctor, who takes over the further follow-up checks.
The extent of this depends on the status of the complaint. Drug treatment is often used. In some cases, a rehabilitation measure follows a stay in the clinic. The patient is specifically prepared there for the return to work and private life. Follow-up care also aims to prevent disease recurrence.
Since phosphine poisoning is an acute and accidental event, this aspect cannot fall within the area of responsibility of a doctor. Instead, those affected must take appropriate protective measures themselves in order not to suffer from phosphine poisoning.
If necessary, the doctor will inform you about suitable measures. Since dangerous contact is usually only possible in everyday work, the safety regulations applicable there must be observed. The employer must provide protective equipment to ensure proper handling.
You can do that yourself
In everyday life, the cleaning and pesticides in your own household or garden should be checked regularly. They should always be kept out of the reach of children and their ingredients should be checked. If existing products contain phosphine, it must be checked whether these items are required due to their effect on the human organism. They must also be marked accordingly so that there is no risk of confusion.
If the products are required, care should be taken when using them. A face mask must be worn and the person concerned should ensure that they do not handle the pesticides in closed rooms. Those affected should obtain detailed information about the mode of action of phosphine from the media or the manufacturers of the products. All people who also have access to the products must be fully informed by the owner and should be made aware of the dangers. It is also helpful to find out in advance about the correct behavior in the event of poisoning.
If the person concerned comes into contact with phosphine as a result of a professional activity, it is necessary to comply with occupational safety regulations on a daily basis. When preparing meals, fresh fruit, vegetables or spices should always be rinsed and cleaned with fresh water before use. The consumption of food that has not been cleaned is to be avoided as a matter of principle.
