Inhalation of Phosphine Gas Following a Fire Associated with Fumigation of Processed Pistachio Nuts

ABSTRACT

On December 10, 2009, a fumigation stack containing aluminum phosphide became soaked with rain water and caught fire at a pistachio processing plant in Kern County, California. Untrained plant personnel responding to the fire had exposure to pyrolysis by-products, particulates, and extinguisher ingredients. Ten workers taken for medical evaluation had respiratory and nonspecific systemic symptoms consistent with exposure to phosphine gas. Six of the 10 workers had respiratory distress, indicated by chest pain, shortness of breath, elevated respiratory rate, or decreased oxygen saturation. Recommendations are made for the management of similar illnesses and prevention of similar exposures.

Keywords:

• Aluminum phosphide
• difficulty of breathing
• eye irritation
• fumigant
• headache
• nausea
• O₂ saturation
• pistachios
• respiratory illness
• spontaneous oxidation
• vomiting

Notes

This work was funded in part under a consulting contract between the California Department of Pesticide Regulation and the University of California, Davis.

i.Only licensed applicators may apply them. Use reporting is required.

ii.Regulatory pest control would include use by county departments of agriculture for rodent control and other uses.

iii.Hospital A, Bakersfield Heart Hospital; Hospital B, Mercy Hospital in Bakersfield; Hospital C, Delano Regional Medical Center.

iv.WHS interview January 12, 2010.

v.WHS interview January 12, 2010.

vi.A noncalcified left upper lung granule, was noted, but no findings likely related to the exposure. Specifically, there was no computed tomographic (CT) evidence of interstitial lung disease.

vii.WHS interview January 12, 2010.

viii.While in triage, O₂ saturation ranged from O2 sat 95% to 97%. Respiration was listed as 16–17 cpm; 2–4 L/min of oxygen was given. Chest was nontender. Breath sounds and chest x-ray were normal.

ix.The examination in the Medical Unit noted “few rhonchi and no rales.” He was given an “aerosol treatment because of an obvious wheezing.”

x.WHS interview January 12, 2010.

xi.WHS interview January 12, 2010.

xii.Patient complained of tingling in both arms lasting for about 10 minutes, occurring twice weekly. On examination, there were decreases in his upper arm reflexes and slight decrease of sensation from the right shoulder to the right fingertips.