The impact of sevelamer in aluminum phosphide poisoning: a preliminary study on mortality

Background

Aluminum phosphide (ALP) poisoning, commonly referred to as rice tablet poisoning, is among the deadliest forms of poisoning. Treatment for aluminum phosphide poisoning is limited to supportive care, as no specific antidote is currently available. Sevelamer is being repurposed as an antidote for phosphine gas poisoning. This study seeks to assess the impact of sevelamer treatment on patients’ outcomes and overall prognosis.

Method

This single-blind trial was conducted on patients suffering from aluminum phosphide poisoning (Oct 2023–Dec 2024). Participants were split into two groups: the control group received standard treatment, while the intervention group received standard treatment plus 2.4 g sevelamer carbonate initially, followed by 800 mg tablets every 8 hours. Data were collected using a study-specific checklist covering demographics, clinical symptoms, lab findings, patient outcomes, hospital stay duration, disease history, and secondary complications.

Results

The control group comprised 19 males (63.3%) and 11 females (36.7%). The sevelamer group, 26 males (81.25%) and 6 females (18.75%). This study demonstrated that sevelamer decreased mortality rates (56.25% compared to 86.7%) and enhanced ejection fraction (from 35.8% to 47.5% post-treatment). On the first day, it significantly raised blood PH (7.13 vs 7.23) and PO2 levels (34 vs 53.67).

Conclusion

This study suggests that sevelamer may serve as an effective antidote for treating aluminum phosphide poisoning. Further research is necessary to confirm its efficacy, determine optimal dosing strategies, and assess potential side effects in clinical settings.