Aluminium phosphide poisoning: management and prevention.

Death by Aluminium phosphide (AIP) and organo-phosphide poisoning are the commonest forms of poisoning in India. Aluminium phosphide is used as rodenticide and pesticide in grain storage facilities. It produces phosphine gas, which results in mitochondrial poisoning. There is no known antidote for AIP poisoning. The effects of AIP poisoning, mediated by phosphine and mechanism of action have not been established.The information related to this poisoning is available in the literature and substantiated by practical experience. Liberated phosphine cannot be detoxified but Magnesium sulphate has been reported to be effective. Another remedy can be rapid absorption by coconut oil which might be helpful. Treatment consists of gastric lavage with potassium permanganate solution, oral administration of charcoal and sorbitol suspension, intravenous administration of sodium bicarbonate, magnesium sulphate and calcium gluconate, and oral administration of sodium bicarbonate and coconut oil. Use of coconut oil for treatment in this poisoning is suggested, although clinical trials and scientific approval is still awaited. Every suggestion, news regarding new modality of treatment for this poisoning needs to be shared in the interest of saving precious human lives. It is with this aim the present paper is written.

Adult choroid plexus papilloma: cause of sudden death.

Choroid plexus papilloma (CPP) is a rare, benign neoplasm, relatively more common in childhood. It is associated with signs and symptoms of increased intracranial pressure, frequently in association with obstructive hydrocephalus. CT and MRI are the investigations of choice and are diagnostic. Sudden deaths have been reported, but are very unusual. A 41 year old male was brought for medico-legal autopsy examination on ground of sudden death. He was reported to have headaches over a long period of time. On autopsy examination, massive sub-arachnoid hemorrhage was seen on both the cerebral hemispheres and cerebellum. A cyst measuring about 1 cm diameter was found in choroid plexus of right lateral ventricle. On histopathological examination, it was found to be a choroid plexus papilloma. Calcification was also evident in the papilloma. From medico-legal aspect, the present case reveals an unusual cause for sudden death in an adult male. The pathology could have been diagnosed easily by CT scan or MRI. When diagnosed, it has good survival rate, the morbidity depending on the extent of pathological effects. The present case was likely to have survived having minimal effects with appropriate treatment had he been diagnosed. The pathology is rare and a suspicion for this pathology in the adult male was not expected, but a CT scan to investigate chronic headache was warranted. Absence of such a suggestion leading to death, which could have been preventable, is sufficient ground for charge of professional negligence.