Early bicarbonate-driven resuscitation and haemodialysis in aluminium phosphide poisoning: Reversing cardiogenic shock

Background and Aims: Aluminium phosphide (ALP) poisoning is associated with high mortality, primarily due to severe metabolic acidosis and cardiogenic shock. Effective, targeted interventions are critical to improving outcomes. The present study aimed to compare early intervention using administration of sodium bicarbonate combined with renal replacement therapy (RRT) compared to conventional management to improve survival in patients with ALP poisoning. Methods: In this observational study, 28 patients with ALP poisoning admitted to the intensive care unit between November 2012 and February 2022 were included (16 retrospectively,12 prospectively). Patients in Group A received gastric decontamination, fluid resuscitation using normal saline upto 20ml/kg, vasopressors, and inotropes administered as needed based on haemodynamic status. Metabolic acidosis was addressed with 8.4% sodium bicarbonate. An early, aggressive resuscitation protocol was implemented for Group B patients, comprising high-volume sodium bicarbonate (20mL/kg) administered in place of conventional crystalloids to rapidly elevate arterial potential of hydrogen (pH) above 7.2. Endogenous bicarbonate production was supported with renal replacement therapy (RRT), without the use of extracorporeal membrane oxygenation. Results: Mean age and gender were comparable between the groups. The difference in lactate levels between the groups was statistically significant at 48 hours ( P < 0.001). Additionally, pH values were significantly different at 12 ( P = 0.011*), 24 ( P < 0.001*), and 48 hours ( P = 0.003). The mortality difference between Group A and Group B was statistically significant with P = 0.047. Conclusion: Uncontrolled metabolic acidosis is the central pathophysiological disturbance in ALP poisoning. Early aggressive correction using high-dose sodium bicarbonate and RRT is recommended to enhance survival.