A case report of zinc phosphide poisoning: complicated by acute renal failure and tubulo interstitial nephritis

Abstract

BackgroundRun Rat® is a rodenticide widely used against small mammals. It comprises of a minimum of 32% zinc phosphide which is highly toxic in acute exposures to humans. It may be consumed accidentally or intentionally. It enters the body via skin, respiratory and gastrointestinal tracts. Zinc phosphide is hydrolyzed by the gastric acid and is transformed into phosphine gas. Phosphine is a respiratory toxin that inhibits cytochrome C oxidase system resulting in renal failure and liver failure.Case presentationA 35 year old Sri Lankan female presented following ingestion of 2.5 g of Run Rat®, which is a branded preparation of zinc phosphide, resulting in 61 mg/kg poison load. She developed severe acute kidney injury with acute tubular necrosis, subnephrotic ranged proteinuria and tubulointerstitial nephritis for which she underwent haemodialysis three times along with other measures of resuscitation. She also developed elevated liver enzymes with hyperblirubinaemia, hypoalbuminaemia, acute pancreatitis and mild myocarditis. She improved with supportive therapy over a period of 3 weeks.ConclusionRun Rat® is a commonly used rodenticide and the toxic effects are mediated through conversion of phosphide to phosphine gas. The majority of the deaths had occurred in the first 12 to 24 h and the main causes identified are refractory hypotension and arrhythmias. The late deaths (beyond 24 h) had been commonly due to adult respiratory distress syndrome, liver and renal failure. The outcome is poorer with delayed presentation, development of coagulopathy, hyperglycaemia and multiorgan failure with elevated liver enzymes. In our patient, Zinc phosphide poisoning caused severe acute kidney injury, abnormal liver profile, pancreatitis and possible myocarditis. The patient improved with repeated haemodialysis. The renal biopsy revealed acute tubulointerstitial nephritis with acute tubular necrosis.In tropical countries, the rural population engaged in agriculture has easier access to the compound, as it is available at a lower cost. Furthermore, the lack of an antidote and advanced resuscitative measures such as inotropic supportive therapy and renal replacement facilities at most of the peripheral hospitals pose a major challenge in providing timely interventions to prevent deaths.

Acute pesticide poisoning amongst adolescent girls and women in northern Tanzania

“…As a chemical endocrine disruptor [56,57] exposure to even small concentrations of Endosulfan can lead to serious health effects. Endosulfan has been banned in Tanzania for health risks since 2013 and it has also been earmarked for elimination under the Stockholm Convention on Persistent Organic Pollutants (POPs) and listed under the Rotterdam Convention on Prior Informed Consent [58]. Zinc phosphide is extremely toxic, causing acute respiratory distress in exposed persons due to the release of phosphine gas when it comes into contact with moisture [59].…”

Successful management of zinc phosphide poisoning—a Hungarian case

“…In some instances, severe ZnP poisoning can lead to cardiac failure, pulmonary edema, fulminant hepatic failure, thrombocytopenia, and disseminated intravascular coagulopathy [22,29] and rarely, intravascular hemolysis and tubulointerstitial nephritis can also develop [30,31]. Acute renal failure has also been reported following aluminum phosphide and ZnP intoxication [4,31]. In line with these reports, our patient's moderately impaired kidney functions upon admission began to deteriorate, with creatinine levels peaking on the third and fourth days.…”

Acute Pesticide Poisoning amongst adolescent girls and women in Northern Tanzania

“…58 Zinc phosphide is extremely toxic, causing acute respiratory distress in exposed persons due to the release of phosphine gas when it comes into contact with moisture. 59 However, it is not registered for use in Tanzania and its distribution is therefore illegal, its use being mainly for domestic rats control. 1 Because the main use of this highly hazardous product occurs within households, the proximity to human habitation is likely to increase risks for human poisoning.…”