Phosphine

CAS RN: 7803-51-2
UN/NA: 2199

Treatment Overview

0.4.3 INHALATION EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) For mild to moderate exposures, the mainstay of treatment is removal from phosphine exposure and supportive care. Monitoring of cardiac, hepatic, and renal functions should occur. Fluid and electrolytes should also be measured, and circulatory and respiratory support given as needed for symptoms.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) For severe overdoses, removal from phosphine exposure and supportive care are the most important initial measures. Severe metabolic acidosis can be treated with sodium bicarbonate and standard treatment for dysrhythmias may be needed. Respiratory distress with pulmonary edema and/or acute lung injury may be treated with supplementary oxygen and mechanical ventilation. Hypotension can be treated initially with fluids and then pressors (ie, dopamine, norepinephrine).
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Move patient to fresh air as soon as possible.
    • 2) HOSPITAL: Administer oxygen. Wash exposed skin and irrigate exposed eyes.
  • D) AIRWAY MANAGEMENT
    • 1) Airway management is one of the primary issues with phosphine toxicity and patients may get critically ill quickly; early intubation may be needed. Patients should be moved to fresh air as soon as possible, and treated with supplemental oxygen and assisted ventilation as needed. Bronchospasm can be treated with B2 agonists and oral or parenteral corticosteroids.
  • E) ANTIDOTE
    • 1) None
  • F) ENHANCED ELIMINATION
    • 1) Dialysis or hemoperfusion are unlikely to be helpful for phosphine exposures.
  • G) PATIENT DISPOSITION
    • 1) HOME CRITERIA: There is no data to support home management.
    • 2) OBSERVATION CRITERIA: All patients with exposures should be sent to a healthcare facility for observation for at least a period of 6 to 8 hours of observation. Patients may be discharged home if they are asymptomatic or clearly improving and stable for discharge. Patients should be instructed to return immediately if any respiratory symptoms develop, as onset of acute lung injury may be delayed.
    • 3) ADMISSION CRITERIA: Patients with worsening or severe symptoms should be admitted to the hospital and, depending on the severity of their symptoms (eg, respiratory distress requiring intubation), may require an ICU bed. Patients can be discharged once they are hemodynamically stable with clear improvement or asymptomatic from their exposure.
    • 4) CONSULT CRITERIA: Consult a medical toxicologist or poison center for any patient with suspected phosphine exposure. An occupational physician and industrial hygienist should be involved if the exposure is work-related. Other helpful consultants may include critical care physicians and pulmonologists to help management of the patient's symptoms.
  • H) PITFALLS
    • 1) One concern from phosphine exposure is that the characteristic odor might be masked by olfactory fatigue at higher concentrations. Patients should be removed from the exposure as the first line treatment. Severe symptoms, such as pulmonary edema, may be delayed for up to 72 hours after exposure.
  • I) TOXICOKINETICS
    • 1) Onset of symptoms may range from immediate to within a few hours. Some toxic manifestations, such as abnormalities in liver enzymes or pulmonary edema, may be delayed for up to 1 to 3 days.
  • J) PREDISPOSING CONDITIONS
    • 1) Patients at extremes of age or underlying morbidities, such as chronic lung disease, may be more susceptible to phosphine exposure.
  • K) DIFFERENTIAL DIAGNOSIS
    • 1) Includes other irritant or toxic gases such as chlorine or cyanide gases.
0.4.4 EYE EXPOSURE
  • A) Eye exposures can be treated with simple decontamination and removal from the exposure area. Irrigate exposed eyes.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) Dermal exposures can be treated with simple decontamination and removal from the exposure area. Wash exposed skin.
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