Agricultural revolution and increasing pesticidal use have brought its share of downsides in the form of pesticidal poisoning. Every year approximately 300,000 deaths happen worldwide due to pesticide poisoning. Organophosphates, chlorates, and aluminum phosphide are the commonly used pesticides. Alkaline phosphatase (ALP) is the most lethal among the available pesticides and no antidote is available and aptly called as suicide poison. The common use and easy availability of ALP is causing acute and chronic health effects which have reached major proportions in Asian and Middle Eastern countries such as India, Bangladesh, Iran, Jordan, and Sri Lanka. Toxicity of ALP is related to prompt release of lethal phosphine gas as ALP tablet absorbs moisture. Phosphine gas mainly affects cardiovascular system gastrointestinal tracts, lungs, and kidneys. The clinical features of poisoning include nausea, vomiting, abdominal pain, pulmonary edema, cyanosis shock arrhythmias, and alter sensorium. Diagnosis of ALP poisoning largely depends on history and clinical setting and treatment is usually initiated without waiting for silver nitrate paper test or gastric aspirate analysis. Treatment includes early gastric lavage symptomatic supportive therapy and palliative care. There has been greater understanding about the mechanism and pathophysiology of ALP toxicity over the years, although that cannot be commented about the treatment modalities. Government efforts to restrict sale have been offset by the lack of strict enforcement by regulatory agencies. Case fatality rates from ALP poisoning have shown some decline over the years due to early supportive management. Different treatment modalities and protocols have been tried at various centers with variable success; however, further research for an antidote is the need of the hour.
Key words: Aluminum Phosphide; Phosphine; Phosphide; Pesticides; Poisoning; Silver Nitrate Test; N-acetylcysteine; Magnesium Sulfate