Deaths have resulted from accidental exposure to fumigation materials containing aluminium phosphide or phosphine. It can be absorbed either by inhalation or transdermally.  As a respiratory poison, it affects the transport of oxygen or interferes with the utilization of oxygen by various cells in the body. Exposure results in pulmonary edema (the lungs fill with fluid). Phosphine gas is heavier than air so it stays near the floor.
Phosphine appears to be mainly a redox toxin, causing cell damage by inducing oxidative stress and mitochondrial dysfunction. Resistance in insects is caused by a mutation in a mitochondrial metabolic gene.
Phosphine can be absorbed into the body by inhalation. The main target organ of phosphine gas is the respiratory tract. According to the 2009 U.S. National Institute for Occupational Safety and Health (NIOSH) pocket guide, and U.S. Occupational Safety and Health Administration (OSHA) regulation, the 8 hour average respiratory exposure should not exceed 0.3 ppm. NIOSH recommends that the short term respiratory exposure to phosphine gas should not exceed 1 ppm. The Immediately Dangerous to Life or Health level is 50 ppm. Overexposure to phosphine gas causes nausea, vomiting, abdominal pain, diarrhea, thirst, chest tightness, dyspnea (breathing difficulty), muscle pain, chills, stupor or syncope, and pulmonary edema. Phosphine has been reported to have the odor of decaying fish or garlic at concentrations below 0.3 ppm. The smell is normally restricted to laboratory areas or phosphine processing since the smell comes from the way the phosphine is extracted from the environment. However, it may occur elsewhere, such as in industrial waste landfills. Exposure to higher concentrations may cause olfactory fatigue.