11:26 p.m
Sunday 04 September 2022
Books – Ahmed Gomaa:
The Ministry of Health and Population has distributed a treatment protocol to deal with cases of “yellow disk” poisoning to the directorates of health affairs and hospitals at the level of the Republic.
The protocol prepared by the Central Department of Urgent and Critical Care at the Ministry included an introductory paper on the yield tablet, including the composition and use, how to be exposed and how to treat poisoning cases, guided by scientific evidence published by Egyptian and international universities in this regard.
The administration stressed that it be circulated to all public, central and qualitative hospitals, and alerted to the commitment to follow what was stated in the protocol.
The treatment protocol – which Masrawy obtained – was directed to prevent the introduction of water into the patient’s stomach or the work of gastric lavage with a solution of potassium permanganate salt.
Yield discs installation
Yield tablets consist of aluminum phosphide compound and are used to preserve crops from decay-causing pests. These tablets are kept in tightly closed containers away from moisture. When using, the storage space for the grains is calculated in sealed rooms or silos, and then the tablets are placed.
When the tablets are exposed to atmospheric humidity, phosphine gas rises to eliminate the pest that affects the grains, and all preventive measures are taken to avoid inhaling phosphine gas.
With regard to the mechanism of poisoning, the protocol referred to inhalation of phosphine gas inside the storage room, or swallowing with the purpose of suicide or neglect within the reach of children.
When the tablet is exposed to stomach acid, phosphine gas is released, a cytotoxic compound that inhibits vital cellular enzymes and causes direct tissue erosion and circulatory collapse, which leads to direct effects on the heart muscle, in addition to fluid loss.
Dealing with cases of yielding disc poisoning:
– The patient is given coconut oil or paraffin oil (from 2-5 bottles of 50 ml) if the patient is able to swallow or via the rail if he is unable to swallow, and the oil is left in the patient’s stomach, as the oil contains the pill and most importantly it maintains the bond between Aluminum and phosphide prevent the rise of phosphine gas, which affects the heart muscle
– Sodium bicarbonate (1-2 IV ampoules) is given as an initial dose before the result of the analysis appears to contain the resulting acidity.
– There is no antidote for treatment and activated charcoal is not given because it has no role.
The patient is transferred to an intensive care unit to receive the necessary supportive measures
– A blood gas analysis is done and the bicarb is corrected in the blood until it reaches 20
– Making an electrocardiogram and heart enzymes to show its effect on the heart. If it is working efficiently, then intravenous solutions are given to raise the pressure. If there is weakness or failure of the heart muscle, do not give intravenous solutions because it will be an extra burden on the heart, and noradrenaline is given by means of a solution pump.
The patient is given an antispasmodic and an injection to reduce absorption
Put the patient on oxygen
Intravenous acetylcysteine may be administered, according to specific doses.