Neurological Manifestations of Aluminum Phosphide (Wheat-Pill/Rice-Pill) Poisoning - A Narrative Review

Sep 30, 2026

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Clinical manifestations from human misdirected ingestion of aluminium phosphide (AlP), marketed as wheat pill or rice pill, span nausea and vomiting through acute respiratory failure, cardiotoxicity, and hepatotoxicity, with potential for sudden death. No standardized regimen currently exists, motivating this narrative review focused on neurological manifestations and treatment options. Eight studies were included, spanning case reports and reviews. Key symptoms included dizziness, headache, weakness, declining consciousness, seizures, coma variability, and motor deficits. Imaging described CT cerebellar and brainstem hypointensity, and MRI diffusion restrictions consistent with global hypoperfusion or acute ischemic infarction. Evidence suggests paraffin oil, co-enzyme Q10, hyperinsulinemia euglycemia, and N-acetylcysteine may reduce mortality, but larger randomized trials are required to confirm benefit.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction And Background

Mechanism of toxicity

Review

How to cite this article

Review began 10/22/2025 Review ended 12/03/2025 Published 12/10/2025 © Copyright 2025 Rasheed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98910 Open Access Review Article Neurological Manifestations of Aluminum Phosphide (Wheat-Pill/Rice-Pill) Poisoning: A Narrative Review Amir Rasheed 1 , Syed Haider Hassan 2, 3, Haseeb Mehmood Qadri 4, 3 , Abu-Bakr Ahmed 5, Muhammad Ahmed 6, Haysum Khan 7, Nusrat Fatima 8, Adeena Azam 9, 3, Saad Abdullah Dar Arham Amir Khawaja 11 1, 10 , 1. Internal Medicine, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, PAK 2. Neurological Surgery, University of Wisconsin, Madison, USA 3. Neurological Surgery, Punjab Institute of Neurosciences, Lahore, PAK 4. General Surgery, Lahore General Hospital, Lahore, PAK 5. School of Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, USA 6. Critical Care, Bahria International Hospital, Lahore, PAK 7. Neurological Surgery, Shifa Tameer-e-Millat University, Shifa College of Medicine, Islamabad, PAK 8. Respiratory Medicine, Portsmouth University Hospital NHS Trust, Portsmouth, GBR 9. Internal Medicine, Allama Iqbal Medical College, Lahore, PAK 10. Surgery, Allama Iqbal Medical College, Lahore, PAK 11. General Surgery and Surgical Oncology, Shaikh Zayed Medical Complex, Lahore, PAK Corresponding author: Haseeb Mehmood Qadri, [haseebmehmood18@yahoo.com](haseebmehmood18@yahoo.com) Abstract The clinical manifestations of Aluminium Phosphide (AlP) that stem from its misdirected human consumption range from nausea and vomiting to acute respiratory failure, cardiotoxicity and hepatotoxicity, causing sudden death. Currently, there is no standard regimen to deal with this menacing product. This review aimed to highlight the neurological manifestations and treatment options for dealing with wheat pill poisoning. After the literature search, a total of eight studies were included in this study. Study types included five case reports, a prospective case series, a retrospective review, and an autopsy with sample sizes ranging from a single patient to 471 patients. The major symptoms included were dizziness, headache, and weakness in both upper and lower extremities. Reported neurological findings included progressive decline in consciousness, anisocoria with non-reactive pupils, loss of consciousness, convulsions, variable coma grades, and motor deficits. The CT brain findings mentioned in one case report were significant for diffuse bilateral hypoattenuation in the cerebellar hemispheres, midbrain, thalamus, and globus pallidus nuclei. MRI brain revealed multiple cortical and subcortical diffusion restrictions in cerebral hemispheres, consistent with prior global hypoperfusion injury in one case report, while the other showed an acute ischemic infarct in the left posterior cerebral artery (PCA) territory involving left medial temporal, parietooccipital lobes, left half of the splenium of the corpus callosum and left thalamus. There is some evidence that paraffin oil, co-enzyme Q10, hyperinsulinemia euglycemia, and Nacetylcysteine (NAC) decrease mortality in this poisoning. However, further large-scale randomised controlled trials are needed to definitively evaluate their mortality benefit. Categories: Forensic Medicine, Neurology, Public Health Keywords: aluminum phosphide, cns, insecticide, low to middle income countries, nausea, neurological, rice pill, rodenticide, vomiting, wheat pill Introduction And Background Aluminium phosphide (AlP) is used as a "wheat pill " or "rice pill " with rodenticide effects. However, it has been misused for poisoning. The clinical manifestations ofAlP range from nausea and vomiting to acute respiratory failure, cardiotoxicity and hepatotoxicity, causing s

FAQs

What range of clinical effects can aluminum phosphide poisoning cause?

Aluminum phosphide poisoning can progress from gastrointestinal symptoms like nausea and vomiting to acute respiratory failure, cardiotoxicity, and hepatotoxicity, potentially leading to sudden death.

What neurological symptoms and findings are commonly reported?

Reported symptoms include dizziness, headache, weakness, progressive decline in consciousness, anisocoria with non-reactive pupils, seizures, variable coma grades, and motor deficits. Imaging findings include CT hypointensity in multiple brain regions and MRI diffusion restrictions consistent with global hypoperfusion injury or acute ischemic infarction.

Are there any treatments shown to reduce mortality?

The review reports evidence that paraffin oil, co-enzyme Q10, hyperinsulinemia euglycemia, and N-acetylcysteine (NAC) may decrease mortality. Larger randomized controlled trials are still needed to confirm the mortality benefit.

Sep 30, 2026

Uploaded by acoobca