Efficacy of intravenous lipid emulsion as an adjunctive therapy for acute aluminum phosphide poisoning: a randomized, open-label, pilot clinical trial

M. Singh Bhatia, R. Attri, A. Saroch, A. Kumar Pannu, N. Singla, S. Chandrabhan Sharda

Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (P.G.I.M.E.R.), Chandigarh, India. saurabhcsharda@gmail.com

---

• Toxicology

OBJECTIVE: Aluminum phosphide poisoning, a leading cause of pesticide-related deaths, has a 70-100% mortality rate and no specific antidote. Intravenous lipid emulsion showed promise in case reports, possibly by sequestering phosphine. This pilot study evaluated the efficacy of intravenous lipid emulsion in reducing mortality and improving outcomes in acute aluminum phosphide poisoning.

MATERIALS AND METHODS: This single-center, randomized, open-label trial enrolled 98 adults with confirmed aluminum phosphide poisoning. Patients received standard care plus intravenous lipid emulsion (20% emulsion, 250 ml bolus then 250 ml over 20 min) or normal saline placebo within 24 h. The primary outcome was all-cause mortality.

RESULTS: Baseline characteristics were similar (N=98; 48 intravenous lipid emulsion, 50 control). Intravenous lipid emulsion group mortality [22.9% (11/48)] was significantly lower than control [62.0% (31/50); relative risk 0.493, 95% confidence interval 0.335-0.725; p<0.001]. Intravenous lipid emulsion led to greater lactate reduction (-2.3 vs. -0.6 mmol/l; p<0.013) and bicarbonate increase (7.0 vs. 2.0 mmol/l; p<0.013). Survival was higher with intravenous lipid emulsion in fresh celphos (71.4% vs. 0%; p<0.001) and shock (50% vs. 0%; p=0.001) subgroups.

CONCLUSIONS: In this pilot trial, intravenous lipid emulsion as an adjunct to standard care significantly reduced mortality and improved metabolic parameters in acute aluminum phosphide poisoning, particularly in high-risk subgroups.

This article has been corrected. Erratum available at: Eur Rev Med Pharmacol Sci 2026; 30 (4): 128-128.

Free PDF Download