A race against time in lethal aluminum phosphide intoxication: a case report

Abstract

Aluminum phosphide (AP) is a condition that results in death in case of use for suicide purpose. The phosphine gas, which is released as a result of aluminum phosphide intake, has high level of toxicity. It leads to cellular level hypoxia and inhibition of oxidative phosphorylation. Aluminum phosphide intoxication may cause metabolic acidosis, arrhythmia, acute respiratory distress syndrome, and shock. High-dose intakes may lead to death within hours. 22 year-old female patient was taken to our emergency service because of the suicide attempt with 6000mg aluminum phosphide tablet. We aimed to share our experience with our aluminum phosphide intoxication, which has no known antidote and leads to rapid death in follow-up. We aim to present our experiences with our case of intoxication from aluminum phosphide, which causes high mortality after the intake. 22 year-old female patient was transferred to our hospital due to suicide attempt with 6000mg aluminum phosphide tablet. The patients have no known comorbidities, medicine use or allergic history. We believe that, in preventing the high mortality rate in aluminum phosphide intoxication, metabolic acidosis, arrhythmia, ARDS and measures against the shock and the hemodialysis in early period should be performed. Although its efficiency has not been clearly proved and its use has not entered into algorithms, the use of MgSO4 and N-Acetyl-Cysteine in supportive care is an option for such cases. Further studies and proven treatment methods are needed in AP toxicity.

Successful management of zinc phosphide poisoning: possible benefit of virgin olive oil

“…Calcium gluconate 10% and magnesium sulphate 25% have also been advocated [5]. The main difference between the treatment protocol done in the present case and those recommended in the literature is the use of virgin olive oil.…”

“…We also applied these therapies. Activated charcoal can decrease the absorption of phosphide particles, which are thought to be responsible for delayed toxic effects [5]. Calcium gluconate and magnesium sulphate have been used with good results, presumably due to their membrane-stabilizing effects and also probably due to the antioxidant effect of magnesium.…”

“…The majority of deaths occur within the first 12-24 hours, usually due to cardiovascular arrest. Deaths occurring after 24 hours are often due to liver failure [5].…”

A Case Who Died Due to the Suicidal Intake of Aluminum Phosphide

“…Because the sales of aluminum phosphides is prohibited in the open markets and their sales by authorized companies are under control. Thus, the number of death cases due to aluminum phosphide intoxication is limited in Turkish literature 11,12 .…”