Human Zinc Phosphide Exposure in Lebanon: A Case Report and Review of the Literature

Abstract

Toxicity from rodenticides such as metal phosphides is common worldwide, particularly in developing countries where consumers have access to unlabeled and uncontrolled insecticides and pesticides.Case Report: We present the first documentation of a metal phosphide exposure in Lebanon. A middle-aged woman presented to the emergency department following the ingestion of an unknown rodenticide. Spectroscopy analysis of the sample brought by the patient was used and helped identify zinc phosphide. The patient developed mild gastrointestinal symptoms and was admitted to the intensive care unit for observation without further complications. Review:We subsequently conducted a literature review to understand the diagnosis, pathophysiology, clinical presentation, and management of metal phosphide toxicity. Multiple searches were conducted on MEDLINE and PubMed, and articles related to the topics under discussion were included in the review. Metal phosphide is associated with significant morbidity and mortality involving all body systems. Patients presenting with metal phosphide intoxication need extensive workup including blood testing, electrocardiogram, and chest radiography. To date there is no antidote for metal phosphide toxicity, and management is mostly supportive. Many treatment modalities have been investigated to improve outcomes in patients presenting with metal phosphide toxicities. Conclusion:Emergency physicians and toxicologists in developing countries need to consider zinc and aluminum phosphides on their differential when dealing with unlabeled rodenticide ingestion. Treatment is mostly supportive with close monitoring for sick patients. Further research is needed to better understand metal phosphide toxicity and to develop better treatment options. [Clin Pract

The first reported mortality from aluminum phosphide poisoning in Lebanon: a case report

“…In Lebanon, a few cases of metal phosphide poisoning have been reported, such as zinc phosphide poisoning, which led to gastrointestinal disturbances and ICU admission, but the patient survived [ 13 ]. This is the first reported ALP poisoning case in Lebanon, resulting in multiorgan failure and death.…”

“…Activated charcoal may be considered for oral ALP ingestion if a patient presents within an hour with no contraindications. Nonetheless, activated charcoal and potassium permanganate may have limited benefits due to the lack of molecular interaction in metal phosphide poisoning [ 13 ]. Antioxidants, like N-acetyl cysteine (NAC), are proposed for ALP poisoning treatment.…”

Pattern and predictors of death from aluminum and zinc phosphide poisoning using multi-kernel optimized relevance vector machine

“…Aluminum Phosphide (AlP) has been reported also to cause methemoglobinemia, hemolysis, and inhibition of the cholinesterase enzyme 4 – 6 . Therfore, these pesticides are a significant cause of morbidity and mortality in developing countries where their use is widespread, as there is no antidote or specific treatment available 7 . Zinc Phosphide (ZnP) is a dark grey crystalline compound used as a rodenticide, which is inexpensive, easily accessible, and highly potent 8 .…”

The Treatment Results in Patients with Aluminum Phosphide Toxicity Admitted to Razi Hospital in Ahvaz

“…Metal phosphides (aluminum, zinc, magnesium, and calcium) have long been accepted as rodenticides and pesticides across the world [1]. Low cost, high strength in killing harmful insects and rodents, leaving no toxic residues, and no adverse consequences on the health of grains are factors contributing to the extensive application of metal phosphides [2].…”