Aluminum Phosphide Poisoning: A Deadly Toxin with Limited Therapeutic Options

Aluminum phosphide (AlP) poisoning is a critical and often fatal toxicological emergency caused by the release of phosphine gas following ingestion or exposure. Widely used as a fumigant pesticide, especially in low- and middle-income countries, AlP poses significant public health challenges due to its high toxicity, rapid onset of multiorgan failure, and lack of a specific antidote. The primary mechanism of toxicity involves inhibition of key mitochondrial enzymes, leading to oxidative stress, impaired cellular respiration, and severe cardiopulmonary complications. Clinical manifestations range from gastrointestinal symptoms to refractory hypotension, arrhythmias, and respiratory distress. Diagnosis is predominantly clinical, supported by specific tests for phosphine detection when available. Management remains largely supportive, focusing on stabilization, decontamination, and mitigation of complications. Despite advances in intensive care, mortality rates remain alarmingly high. This review summarizes the current understanding of AlP poisoning, highlighting pathophysiology, clinical features, diagnostic approaches, and therapeutic challenges, while emphasizing the urgent need for preventive strategies and novel antidotal therapies.