Acute-onset Breathlessness: An Unexpected Etiology?

Acute-onset breathlessness has multifactorial causes where early spotting of etiology assists in prompt treatment of these cases. Other than usual causes, an often-neglected cause, especially in adults, is non-asphyxiating foreign body aspiration. Here, we describe a case of a 40-year-old male who had aspirated an organic foreign body under alcohol intoxication and presented with symptoms of acute-onset breathlessness and severe hypoxia. Prompt diagnosis and bronchoscopy-guided removal result in a quick recovery of symptoms in the index patient. How to cite this article: Anbalagan LC, Muthu V, Pannu AK, Saroch A. Acute-onset Breathlessness: An Unexpected Etiology? Indian J Crit Care Med 2022;26(2):231-234.

Management of Acute Aluminum Phosphide Poisoning: Has Anything Changed?

Due to its easy availability, rapid and severe toxicity, and no specific antidote, aluminum phosphide has emerged as a lethal toxin, commonly used for suicidal intent in agricultural communities. Despite various advances in medicine, this compound's toxicity is poorly understood, and it still has a very high case fatality rate with no definitive treatment options available. This review aims to understand the mechanism of toxicity, clinical toxidrome of acute aluminum phosphide poisoning, and the available therapeutic options, including recent advances. A literature review was performed searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: ("aluminum phosphide poisoning" OR "aluminum phosphide poisoning toxicity" OR "aluminum phosphide ingestion") AND ("management" OR "therapy" OR "treatment"). Selected articles were discussed amongst all the authors to shape this review. High case fatality rate and lack of any specific antidote are persisting challenges. Therapeutic measures need to be implemented from all fronts - reducing easy access to the poison, developing less toxic alternatives for use as a pesticide, and more studies directed at developing an effective reversal agent for phosphine. The advent of promising agents like glucose-insulin-potassium infusion and lipid emulsion is a new ray of hope in the complete recovery in this fatal poisoning. The need of the hour is to find an agent that rapidly and effectively reverses aluminum phosphide's toxic effects. Large multicenter controlled trials are required to establish the role of glucose-insulin-potassium and lipid emulsion.