Objective: To determine the clinical manifestations and prognosis of victims presenting with wheat pill poisoning. Study Design: Prospective Cohort Study. Setting: Emergency Department in District Headquarter Hospital DG Khan. Period: February 2019 to January 2020. Material & Methods: Patients admitted with history of accidental or suicidal wheat pills poisoning were followed over a period of 3 to 6 months. Symptomatic treatment was initially given for 2-3 hours. The patients were retained in CCU for 24 hours before shifting to ward. Research tool (proforma) was designed for collection and interpretation of data. Acute Physiology and Chronic Health Evaluation Score 2 (APACHE-2) score was used for prognosis and recovery. Result: Out of 96 victims of aluminum phosphide ingestion male/female ratio was 2:1, 64% (n= 64) were females and 36% (n=32) were males. Higher incidence was found in age group (16–25 years (n= 27 victims). Overall mortality was 63 (65.6%). Conclusion: Wheat pill was a poison of choice among teens and adults in Pakistan as it is freely available and cheap. Arrhythmia and metabolic acidosis are the major causes of death after wheat pills ingestion. Coconut oil was found effective in delaying the absorption.