title: Investigation of a fatality from nonoccupational aluminum phosphide exposure: measurement of aluminum in tissue and body fluids as a marker of exposure.
abstract: This case study reports our clinical and laboratory investigation of the accidental death of a pregnant rural woman related to phosphine exposure from stored grain fumigated with aluminum phosphide (AIP3) pellets. Environmental data (housing proximity to fumigated grain and meteorologic conditions at the time) coupled with clinical data (tachycardia and the rapid development of pulmonary edema with no antecedent clinical abnormalities) suggested possible toxicant effects. Gross and microscopic autopsy findings demonstrated pulmonary edema. Because phosphine generated from the phosphide is highly reactive and unstable, our laboratory strategy for this investigation focused on the quantitative analysis of aluminum (AI) in blood, gastric contents, and in lung tissue to test the possibility of fumigant intoxication. We recovered 713 ng/ml Al from blood (normal laboratory range 2 to 42 ng/ml). Laser mass spectral analysis of lung tissue demonstrated high concentrations of Al in alveolar macrophages (> 200 ppm) with little or no Al in adjacent lung tissue. Control lung tissue from an urban autopsy case matched by age, sex, and smoking habits showed no demonstrable Al. We conclude that Al may be a useful marker for AIP3 exposure.
authors.affiliation: University of Minnesota School of Medicine, Department of Laboratory Medicine and Pathology, Minneapolis 55414.
authors.forename: V F
authors.initials: VF
authors.lastname: Garry
authors.forename: P F
authors.initials: PF
authors.lastname: Good
authors.forename: J C
authors.initials: JC
authors.lastname: Manivel
authors.forename: D P
authors.initials: DP
authors.lastname: Perl
mesh_terms: D000328:Adult; D000535:Aluminum / Q000032:analysis* / Q000097:blood; D017607:Aluminum Compounds / Q000506:poisoning*; D004781:Environmental Exposure; D017809:Fatal Outcome; D005260:Female; D005651:Fumigation; D006801:Humans; D008168:Lung / Q000737:chemistry; D016676:Macrophages, Alveolar / Q000737:chemistry; D010575:Pesticides / Q000506:poisoning*; D010720:Phosphines / Q000506:poisoning*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D012423:Rural Health
chemical_list: D017607:Aluminum Compounds; D010575:Pesticides; D010720:Phosphines; D000535:Aluminum; C001864:aluminum phosphide