Toxicology: aluminium phosphide poisoning: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Toxicology: aluminium phosphide poisoning

Sample item

A 24-year-old man ingested rice-preserving tablets about an hour ago. He has vomiting with a garlic-like odour on his breath, severe hypotension unresponsive to fluids, tachycardia and metabolic acidosis. Which statement describes the treatment best?

AAtropine and pralidoximeBFomepizole infusionCHydroxocobalamin infusionDEarly supportive care and haemodynamic support, as there is no specific antidote

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Early supportive care and haemodynamic support, as there is no specific antidote

Aluminium phosphide releases phosphine gas in the stomach, which inhibits mitochondrial cytochrome oxidase and causes refractory cardiogenic shock, arrhythmias and metabolic acidosis. It is a common agricultural poison in India with high mortality and no specific antidote. Treatment relies on early decontamination, vasopressors, correction of acidosis, magnesium sulphate in some protocols and intensive care.

Option by option

A. Atropine and pralidoxime
Atropine and pralidoxime are for organophosphate poisoning, which features cholinergic signs rather than a garlic odour with refractory shock.
B. Fomepizole infusion
Fomepizole blocks alcohol dehydrogenase in methanol and ethylene glycol poisoning.
C. Hydroxocobalamin infusion
Hydroxocobalamin is a cyanide antidote and is not proven for phosphine toxicity.
D. Early supportive care and haemodynamic support, as there is no specific antidote (correct)
Correct. Management is supportive because no specific antidote exists.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Early supportive care and haemodynamic support, as there is no specific antidote. Aluminium phosphide releases phosphine gas in the stomach, which inhibits mitochondrial cytochrome oxidase and causes refractory cardiogenic shock, arrhythmias and metabolic acidosis.

Why is "Atropine and pralidoxime" not the answer?

Atropine and pralidoxime are for organophosphate poisoning, which features cholinergic signs rather than a garlic odour with refractory shock.

Why is "Fomepizole infusion" not the answer?

Fomepizole blocks alcohol dehydrogenase in methanol and ethylene glycol poisoning.

Why is "Hydroxocobalamin infusion" not the answer?

Hydroxocobalamin is a cyanide antidote and is not proven for phosphine toxicity.

What concept does this question test?

It tests Toxicology: aluminium phosphide poisoning in General Medicine. It is a common agricultural poison in India with high mortality and no specific antidote. Treatment relies on early decontamination, vasopressors, correction of acidosis, magnesium sulphate in some protocols and intensive care.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Toxicology: aluminium phosphide poisoning?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.