Medical Management Guidelines for Phosphine
(PH3)
CAS# 7803-51-2, Also: Aluminum Phosphide 20859-73-B, Zinc Phosphide 1314-84-7
UN# 2199, Aluminum Phosphide 1397, Zinc Phosphide 1714
PDF Versionpdf icon[174 KB]
Synonyms of phosphine include hydrogen phosphide, phosphorus hydride, phosphorus trihydride, and phosphoretted hydrogen.
- Persons exposed only to phosphine gas do not pose substantial
risks of secondary contamination; however, persons exposed
to solid phosphides may present such risks. Metallic phosphides
on clothes, skin, or hair can react with water or moisture
to generate phosphine gas. Vomitus containing phosphides
can also off-gas phosphine.
- Phosphine is extremely flammable and explosive; it may
ignite spontaneously on contact, with air. Phosphine has
a fish- or garlic-like odor, but may not provide adequate
warning of hazardous concentrations. When phosphine burns
it produces a dense white cloud of phosphorus pentoxide,
P2O5 fume. This fume is a severe respiratory
tract irritant due to the rapid formation of orthophosphoric
acid, H3PO4, on contact with water.
- Phosphine is a respiratory tract irritant that attacks
primarily the cardiovascular and respiratory systems causing
peripheral vascular collapse, cardiac arrest and failure,
and pulmonary edema.
- Most phosphine exposures occur by inhalation of the gas
or ingestion of metallic phosphides, but dermal exposure
to phosphides can also cause systemic effects.
General Information
Description
Phosphine is a colorless, flammable,
and toxic gas with an odor of garlic or decaying fish. It
can ignite spontaneously on contact with air. The gas is shipped
as a liquefied, compressed gas.
Aluminum phosphide (Celphos, Phostoxin,
Quick Phos) and zinc phosphide are solids used as grain fumigants
and as a rodenticide, respectively. Zinc phosphide is often
mixed with bait food such as cornmeal, which can be a danger
to pets and children. When phosphides are ingested or exposed
to moisture, they release phosphine gas. Phosphine gas may
also be released when acetylene is made by the action of water
on calcium carbide which is contaminated with calcium phosphide
as is commonly the case.
Routes of Exposure
Inhalation
Inhalation is the major route of phosphine
toxicity. Odor is not an adequate indicator of phosphine's
presence and may not provide reliable warning of hazardous
concentrations. The OSHA PEL of 0.3 ppm is within the
range of reported odor thresholds. Phosphine is heavier than
air and may cause asphyxiation in enclosed, poorly ventilated,
or low-lying areas.
Children exposed to the same levels
of phosphine as adults may receive a larger dose because they
have greater lung surface area:body weight ratios and increased
minute volumes:weight ratios. In addition, they may be exposed
to higher levels than adults in the same location because
of their short stature and the higher levels of phosphine
found nearer to the ground.
Skin/Eye Contact
Phosphides may be absorbed dermally,
especially through broken skin, and can cause systemic toxicity
by this route. Phosphine gas produces no adverse effects on
the skin or eyes, and contact does not result in systemic
toxicity. Contact with liquefied or compressed phosphine gas
may cause frostbite.
Ingestion
Ingestion of phosphine is unlikely because
it is a gas at room temperature. Ingestion of metallic phosphides
can produce phosphine intoxication when the solid phosphide
contacts gastric acid.
Sources/Uses
Phosphine is produced when metallic
phosphides (e.g., aluminum, calcium, or zinc phosphides) react
with water or acid. Both aluminum and zinc phosphides are
used as rodenticides. Phosphine may be produced during the
generation of acetylene gas. Phosphine is used in the semiconductor
industry to introduce phosphorus into silicon crystals as
an intentional impurity. Phosphine is also used as a fumigant
and a polymerization initiator.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 0.3 ppm (averaged over an 8-hour workshift)
NIOSH IDLH (immediately dangerous to
life or health) = 50 ppm
ERPG-2 (Emergency Response Planning
Guideline) (maximum airborne concentration below which it
is believed nearly all individuals could be exposed for up
to 1 hour without experiencing or developing irreversible
or other serious adverse health effects or symptoms that could
impair an individuals's ability to take protective action)
= 0.5 ppm
Physical Properties - Calcium Hypochlorite
Description: Colorless gas; odor
of garlic or decaying fish
Warning properties: Inadequate;
nonirritating and garlic-like or fishy odor at 1 to 3 ppm.
Molecular weight: 34.0 daltons
Melting point: -209ĀŗF (-134ĀŗC)
Boiling point (760 mm Hg): = -126ĀŗF
(- 87.7ĀŗC)
Vapor pressure: >760 mm Hg
at 68ĀŗF (20ĀŗC)
Gas density: 1.17 (air = 1)
Water solubility: Slightly water
soluble (0.3% at 68ĀŗF) (20ĀŗC)
Flammability: Extremely flammable
and explosive; may ignite spontaneously on contact with air.
Incompatibilities
Phosphine reacts with air, oxidizers,
chlorine, acids, moisture, halogenated hydrocarbons, and copper.
Health Effects
- Symptoms of phosphine intoxication are primarily related
to the cardiovascular and pulmonary systems and may include
restlessness, irritability, drowsiness, tremors, vertigo,
diplopia, ataxia, cough, dyspnea, retrosternal discomfort,
abdominal pain, and vomiting.
- The same symptoms may occur after ingestion of phosphide
salts. Multiple signs may be seen representing various stages
of cardiovascular collapse.
- Phosphine interferes with enzymes and protein synthesis,
primarily in the mitochondria of heart and lung cells. As
a result, effects may include hypotension, reduction in
cardiac output, tachycardia, oliguria, anuria, cyanosis,
pulmonary edema, tachypnea, jaundice, hepatosplenomegaly,
ileus, seizures, and diminished reflexes.
Acute Exposure
Phosphine interferes with enzymes and
protein synthesis, primarily in the mitochondria of heart
and lung cells. Metabolic changes in heart muscle cause cation
disturbances that alter transmembrane potentials. Ultimately,
cardiac arrest, peripheral vascular collapse and pulmonary
edema can occur. Pulmonary edema and pneumonitis are believed
to result from direct cytotoxicity to the pulmonary cells.
In fatal cases, centrilobular necrosis of the liver has also
been reported.
Most deaths occur within the first 12
to 24 hours after exposure and are cardiovascular in origin.
If the patient survives the initial 24 hours, the ECG typically
returns to normal, indicating that heart damage is reversible.
Deaths after 24 hours are usually due to liver failure.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
CNS
Phosphine is a CNS depressant. Initial
effects may include headache, restlessness, dizziness, loss
of feeling, impaired gait, trembling of the extremities during
movement, and double vision. Severe exposure can cause seizures
and coma.
Respiratory
Toxicity that occurs after inhalation
is characterized by chest tightness, cough, and shortness
of breath. Severe exposure can cause accumulation of fluid
in the lungs, which may have a delayed onset of 72 hours or
more after exposure. Pulmonary symptoms can also result from
ingestion of metallic phosphides (e.g., aluminum or zinc phosphide).
Children may be more vulnerable because
of relatively increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
Cardiovascular
Cardiovascular manifestations include
hypotension, reduction in cardiac output, tachycardia, irregular
heart beat, or cardiac arrest. Laboratory tests may reveal
abnormal myocardial enzymes. Phosphine affects the small peripheral
vessels, causing a profound decrease in systemic vascular
resistance. Vascular changes may lead to marked low blood
pressure that does not respond well to pressor agents.
Gastrointestinal
Gastrointestinal symptoms are usually
the first to occur after exposure. Symptoms may include nausea,
vomiting, abdominal pain, and diarrhea.
Hepatic
Typically, liver injury does not become
evident until 48 to 72 hours after exposure. Findings may
include jaundice, enlarged liver, elevated serum transaminases,
and increased bilirubin in the blood.
Renal
Blood and protein in the urine, and acute
kidney failure can occur.
Electrolyte
Analysis of blood gases may reveal combined
respiratory and metabolic acidosis. Also, there have been
reports of significant hypomagnesemia and hypermagnesemia
associated with massive focal myocardial damage.
Potential Sequelae
Although most survivors of acute phosphine
exposure show no permanent disabilities, damage due to insufficient
blood supply to the heart and brain have been reported. Subacute
poisoning resulting from exposure for a few days may cause
reactive airways dysfunction syndrome (RADS) months later.
Chronic Exposure
Chronic exposure to very low concentrations
may result in anemia, bronchitis, gastrointestinal disturbances,
and visual, speech, and motor disturbances. Chronic exposure
may be more serious for children because of their potential
longer latency period.
Carcinogenicity
The EPA has determined that phosphine
is not classifiable as to its human carcinogenicity.
Reproductive and Developmental Effects
Phosphine is not contained in the TERIS
or Reprotext
databases, nor is it mentioned in Shepards Catalog of Teratogenic
Agents. Phosphine is not included in Reproductive and
Developmental Toxicants, a 1991 report published by the
U.S. General Accounting Office (GAO) that lists 30 chemicals
of concern because of widely acknowledged reproductive and
developmental consequences.
No teratogenic effects form acute exposure
are known.
Prehospital Management
- Victims exposed only to phosphine gas do not pose substantial
risks of secondary contamination to personnel outside the
Hot Zone. Victims exposed to solid phosphides, which react
with moisture to produce phosphine, can pose such risks
if phosphides are on clothes, skin, or hair. Protect personnel
through the use of rubber gloves and aprons.
- Phosphine is a multisystem toxicant that can cause pulmonary
irritation, CNS depression, and cardiovascular collapse.
- There is no antidote for phosphine poisoning. Treatment
consists of support of respiratory and cardiovascular functions.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
Rescuer Protection
Phosphine is a highly toxic systemic
poison and a severe respiratory tract irritant.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of phosphine.
Skin Protection: Chemical-protective
clothing is not generally required because phosphine gas is
not absorbed through the skin, and skin irritation is unlikely.
Use rubber gloves and aprons with victims exposed to phosphides.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Brush powder from the skin, hair, and
clothes of victims before leaving the Hot Zone.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of chemically
contaminated children, such as measures to reduce separation
anxiety if a child is separated from a parent or other adult.
Decontamination Zone
Victims exposed only to phosphine gas
do not need decontamination. They may be transferred immediately
to the Support Zone. Victims exposed to metallic phosphides
will require decontamination as described below.
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Brush all visible particles from
clothes, skin, and hair. Remove and double-bag contaminated
clothing and personal belongings.
Thoroughly flush exposed skin and hair
with water for 3 to 5 minutes, then wash with mild soap. Rinse
thoroughly with water. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
If phosphides have been ingested, do
not induce emesis. Phosphides will release phosphine in
the stomach; therefore, watch for signs similar to those produced
by phosphine inhalation. Administer a slurry of activated
charcoal at 1 gm/kg (usual adult dose 60-90 g, child dose
25-50 g). A soda can and a straw may be of assistance when
offering charcoal to a child.
Consider appropriate management of chemically
contaminated children at the exposure site. Also, provide
reassurance to the child during decontamination, especially
if separation from a parent occurs. If possible, seek assistance
from a child separation expert.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims exposed to metallic
phosphides have been decontaminated properly (see Decontamination
Zone above). Victims who have been exposed only to phosphine
gas or who have undergone decontamination pose no serious
risks of secondary contamination. Support Zone personnel require
no specialized protective gear in such cases.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Ensure adequate respiration and pulse. Administer supplemental
oxygen as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
If phosphides have been ingested, do
not induce emesis. If it has not been given previously
and the patient is alert and able to swallow, administer a
slurry of activated charcoal at 1 gm/kg (usual adult dose
60-90 g, child dose 25-50 g). A soda can and a straw may be
of assistance when offering charcoal to a child. Phosphides
will release phosphine in the stomach; therefore, watch for
signs similar to those produced by phosphine inhalation.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
If evidence of shock or hypotension is
observed begin fluid administration. For adults, bolus 1,000
mL/hour intravenous saline or lactated Ringer's solution if
blood pressure is under 80 mm Hg; if systolic pressure is
over 90 mm Hg, an infusion rate of 150 to 200 mL/hour is sufficient.
For children with compromised perfusion administer a 20 mL/kg
bolus of normal saline over 10 to 20 minutes, then infuse
at 2 to 3 mL/kg/hour.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If metallic phosphides have been ingested,
prepare the ambulance in case the victim vomits toxic material.
Have ready several towels and open plastic bags to quickly
clean up and isolate vomitus.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for further advice regarding
triage of multiple victims.
Because it is difficult to determine
at the scene which patients have had the most serious inhalation
exposure, and because some systemic symptoms may be delayed
for up to 72 hours after exposure, all patients who have potentially
significant exposures should be transported to a medical facility
for evaluation. Those who have had massive exposures and those
who have experienced a garlic- or fish-like odor should be
transported first.
All patients who have ingested phosphides
should be transported to a medical facility without delay.
Emergency Department Management
- Victims exposed only to phosphine gas do not pose substantial
risks of secondary contamination to personnel outside the
Hot Zone. However, solid phosphides, which react with moisture
to produce phosphine, may present secondary contamination
risks on clothes, skin, or hair.
- Phosphine is a multisystem toxicant that causes acute
pulmonary irritation, CNS depression, and cardiovascular
collapse. Fatal outcomes after the initial 24 hours are
usually due to hepatic or renal failure.
- There is no antidote for phosphine poisoning. Treatment
consists of support of respiratory and cardiovascular functions.
Decontamination Area
Previously decontaminated patients and
patients exposed only to phosphine gas may be transferred
immediately to the Critical Care Area. Other patients will
require decontamination as described below.
Be aware that use of protective equipment
by the provider may cause fear in children, resulting in decreased
compliance with further management efforts. Rubber gloves
and aprons should be used with non-decontaminated victims
exposed to phosphides.
Emergency room personnel should examine
children's mouths because of the frequency of hand-to-mouth
activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, surgically create an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or have seizures or ventricular arrhythmias should be treated
in the conventional manner.
Correct acidosis in the patient who
has coma, seizures or cardiac dysrhythmias by administering
intravenously sodium bicarbonate (adult dose = 1 ampule; pediatric
dose = 1 Eq/kg). Further bicarbonate therapy should be guided
by ABG measurements.
Basic Decontamination
Patients who are able may assist with
their own decontamination. If the patient has been exposed
to solid phosphides, brush the powder from skin, hair, and
clothes. Remove and double-bag the patient's clothing and
personal belongings. Flush the skin and hair with water (preferably
under a shower). Remove contact lenses if easily removable
without additional trauma to the eye. Use caution to avoid
hypothermia when decontaminating children or the elderly.
Use blankets or warmers when appropriate.
In cases of phosphide ingestion, do
not induce emesis. If activated charcoal has not been
given previously, administer a slurry of it at 1 gm/kg (usual
adult dose 60-90 g, child dose 25-50 g). Phosphides will release
phosphine in the stomach; therefore, watch for signs similar
to those produced by phosphine inhalation. (More information
is provided in Ingestion Exposure under Critical
Care Area below).
Critical Care Area
Be certain that patients who have ingested
solid phosphides have been decontaminated as described above.
Decontamination is not necessary for patients exposed only
to phosphine gas.
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Watch for
signs of airway compromise. Monitor cardiac rhythm.
Hypotension may develop and may respond
poorly to pressor agents.
Patients who are comatose or have seizures
should be treated in the conventional manner. Correct acidosis
in the patient who has coma, seizures or cardiac dysrhythmias
by administering intravenously sodium bicarbonate (adult dose
= 1 ampule; pediatric dose = 1 Eq/kg).
Inhalation Exposure
Symptomatic patients should receive supplemental
oxygen for dyspnea and should be observed for at least 72
hours with repeated chest examinations and other appropriate
studies. Follow-up as clinically indicated.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Ingestion Exposure
Remove phosphides from the stomach as
soon as possible because most phosphides release phosphine
gas on contact with water or acids. Administer a slurry of
activated charcoal at 1 gm/kg (usual adult dose 60-90 g, child
dose 25-50 g), if it has not been given previously. A mineral
oil cathartic (100 mL) is recommended rather than a saline
cathartic. Watch for signs and symptoms similar to those produced
by inhalation exposure; treat accordingly.
Gastric lavage with a potassium permanganate
solution (1:10,000) is recommended if ingestion occurred.
Permanganate oxidizes phosphine in the stomach to form phosphate,
thus reducing the available phosphine.
Antidotes and Other Treatments
There is no antidote for phosphine poisoning.
Treatment consists of supportive measures. Hemodialysis is
recommended only if renal failure develops. The effectiveness
of exchange transfusions is questionable. The value of steroids
for phosphine-exposed patients who develop acute pulmonary
symptoms has not been proven.
Laboratory Tests
Routine laboratory studies for all exposed
patients include CBC, glucose, and electrolyte determinations.
Additional studies for patients exposed to phosphine include
ECG monitoring, renal function tests, and liver-function tests.
Chest radiography, pulse oximetry (or ABG measurements), and
PFl3 are recommended to establish baseline for pulmonary status.
Serial myocardial enzyme levels may also be helpful.
Phosphine is metabolized to phosphite and hypophosphite, which
are excreted in the urine. Although analysis for these metabolites
is not clinically useful in an emergency setting, urine samples
can be collected and frozen for future analysis, particularly
if questions on the nature or extent of exposure are likely.
Disposition and Follow-up
Decisions to admit or discharge a patient
should be based on exposure history, physical examination,
and test results.
Delayed Effects
Because onset of pulmonary edema and
liver damage may be delayed for 72 hours or more after exposure,
all patients who have significant exposure should be admitted
and observed carefully.
Patient Release
Asymptomatic patients who have normal
initial examinations, minimal exposure, and no signs of toxicity
after observation for 4 to 6 hours may be discharged with
instructions to return to the ED if symptoms develop (see
the Phosphine-Patient Information Sheet below).
Follow-up
Obtain the name of the patient's primary
care physician so the hospital can send a copy of the ED visit
to the patient's doctor.
Patients exposed to phosphine should
be monitored for pulmonary dysfunction.
Reporting
If a work-related incident has occurred,
you may be legally required to file a report; contact your
state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
phosphine.
Print this handout only.pdf icon[45 KB]
What is phosphine?
Phosphine is a toxic gas that has no
color and smells like garlic or fish. A serious exposure to
phosphine could occur, however, even if a person does not
smell it. Phosphine is used widely in the semiconductor industry.
Phosphine may be encountered in grain storage silos where
it has been used as a fumigant, or zinc phosphide has been
put down as a rat poison.
Certain pesticides containing zinc phosphide
or aluminum phosphide can release phosphine when they come
in contact with water or acid. The phosphine formed in the
stomach when these solid phosphides are swallowed can result
in phosphine poisoning.
What immediate health effects can be caused by exposure to phosphine?
Exposure to even small amounts of phosphine
can cause headache, dizziness, nausea, vomiting, diarrhea,
drowsiness, cough, and chest tightness. More serious exposure
can cause shock, convulsions, coma, irregular heartbeat, and
liver and kidney damage. Generally, the more serious the exposure,
the more severe the symptoms.
Can phosphine poisoning be treated?
There is no antidote for phosphine, but
its effects can be treated, and most exposed persons get well.
Persons who have experienced serious symptoms may need to
be hospitalized.
Are any future health effects likely to occur?
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a severe exposure, symptoms usually
begin immediately but might not appear for 72 hours or more.
Some severely exposed persons have experienced
long-term brain, heart, lung, and liver injury.
What tests can be done if a person has been exposed to phosphine?
There are no specific blood or urine
tests for phosphine itself. Breakdown products of phosphine
can be measured in urine, but the result of this test is generally
not useful to the doctor. If a severe exposure has occurred,
blood and urine analyses and other tests may also show whether
the brain, lungs, heart, liver, or kidneys have been damaged.
Testing is not needed in every case.
Where can more information about phosphine be found?
More information about phosphine can
be obtained from your regional poison control center; your
state, county, or local health department; the Agency for
Toxic Substances and Disease Registry (ATSDR); your doctor;
or a clinic in your area that specializes in occupational
and environmental health. If the exposure happened at work,
you may wish to discuss it with your employer, the Occupational
Safety and Health Administration (OSHA), or the National Institute
for Occupational Safety and Health (NIOSH). Ask the person
who gave you this form for help in locating these telephone
numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only.pdf icon[45 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing or wheezing
- difficulty breathing or shortness of breath
- chest pain or tightness
- headache, dizziness, tremor, or double vision
- difficulty walking
- nausea, vomiting, diarrhea, or stomach pain
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.