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Could hydroxyethyl starch be a therapeutic option in management of acute aluminum phosphide toxicity?

Abstract
Acute aluminum phosphide poisoning is a serious toxicity and results in high mortality rate despite the progress of critical care. After ingestion, phosphine gas is released and absorbed quickly, causing systemic poisoning and cell hypoxia. Excessive thirst, severe hypotension, arrhythmias, tachypnea, and severe metabolic acidosis are the common clinical manifestations. We think acute metabolic response which characteristically occurs in severe injury also happens in aluminum phosphide poisoning. Necropsy examinations indicate congestion in almost all vital organs because of leakage of fluids from intravascular to extravascular space. The most favorable type of fluid for intravascular volume resuscitation persists and is disputed. Colloids remain in the intravascular space rather than crystalloids, and provide more rapid hemodynamic stabilization. Furthermore, hydroxyethyl starch solution may have other benefits e.g. it can reduce the extra vascular leak of albumin and fluids from an endothelial injury site. As refractory hypotension and cardiovascular collapse, because leakage of fluids from intravascular to extravascular space are common cause of death in this toxicity, we propose that hydroxyethyl starch can dominate this refractory hypotension and consequently acute metabolic response.
AuthorsSayed Mahdi Marashi, Mohammad Arefi, Behnam Behnoush, Mahdi Ghazanfari Nasrabad, Zeynab Nasri Nasrabadi
JournalMedical hypotheses (Med Hypotheses) Vol. 76 Issue 4 Pg. 596-8 (Apr 2011) ISSN: 1532-2777 [Electronic] United States
PMID21288649 (Publication Type: Journal Article)
CopyrightCopyright © 2011 Elsevier Ltd. All rights reserved.
Chemical References
  • Aluminum Compounds
  • Antidotes
  • Hydroxyethyl Starch Derivatives
  • Phosphines
  • Water Pollutants, Chemical
  • aluminum phosphide
Topics
  • Acute Disease
  • Aluminum Compounds (poisoning)
  • Antidotes (therapeutic use)
  • Humans
  • Hydroxyethyl Starch Derivatives (therapeutic use)
  • Phosphines (poisoning)
  • Water Pollutants, Chemical (poisoning)

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