Hepatotoxicity due to zinc phosphide poisoning in two patients: role of N‐acetylcysteine

Abstract

Key Clinical MessageZinc phosphide (Zn3P2/ZnP) is used as a rodenticide. The most common signs of toxicity are nausea, vomiting, hypotension, and metabolic acidosis; patients presenting such signs are referred to the emergency department (ED) of the hospitals. Therefore, this study aimed to report two cases of hepatotoxicity following accidental and intentional ZnP poisoning and successful management with N‐acetylcysteine (NAC).

Successful Treatment of Heart Failure Due to Simultaneous Poisoning with Aluminum Phosphide and Zinc Phosphide: A Case Report

“…Consistent with our findings, previous studies have shown that the most common clinical signs of AlP and ZnP poisoning include vomiting, abdominal pain, palpitation, dyspnea, tachypnea, metabolic acidosis, shock, and hypotension. Furthermore, studies have indicated that hepatic enzymes might increase during poisoning (6,15). The most important dissimilarity of ZnP and AlP poisoning is the relatively longer time of symptom appearance upon poisoning by ZnP.…”

“…It can change into cysteine or mercaptate conjugates in acetaminophen (N-acetyl-p-benzoquinone imine) or poisoning due to mercury consumption. Therefore, many poisoned patients, who are treated with NAC, do not show hepatotoxicity and are only hospitalized for a short period (6,16).…”

“…On the other hand, ZnP is in powder form. It is more slow-acting than AlP and has a lethal dose of 4 -8 g (6). Mortality due to ZnP poisoning reportedly ranges from 37% to 100% (6).…”

“…Mortality due to ZnP poisoning reportedly ranges from 37% to 100% (6). With respect to the mortality rates, these compounds are associated with high mortality, while no specific antidotes have been yet recommended (6,7).…”

Zinc phosphide poisoning with unusual radiologic findings

“…Metal phosphides such as aluminum phosphide and zinc phosphide (Zn 3 P 2 ) are among the most potent rodenticides. In both humans and rodents, gastric acid reacts with phosphide to generate toxic phosphine gas, a highly lethal compound .…”