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

Abstract

Metal phosphides in general and zinc phosphide, in particular, are potent insecticides and rodenticides. These are commercially used for protection of crops during storage, as well as during transportation. However, these are highly toxic substances. Zinc phosphide (Zn2P3) and other phosphides are generally misused intentionally for suicidal purpose in Turkey. While most fatal PH3 exposures are unintentional, metal phosphide pellet ingestion has been used intentionally as a means of suicide in several Asian countries and in Europe. Once ingested, zinc phosphide is decomposed into highly toxic phosphine gas by the action of a dilute hydrochloric acid content of the stomach. Phosphine acts as a respiratory poison. Even 20:100,000 part of phosphine in the air is reported to fatal. Their detrimental effects may range from nausea and headache to renal failure and death. It's poisoning has a high mortality and recent years have seen an increase in the number of poisoning cases and deaths caused by suicidal ingestion. In episodes of metal phosphide poisoning, the treatment depends on the route of exposure. We aimed to present an intentionally ingested Zn2P3 of 15 g patient on suicide purpose and our therapy with orally NaHCO3, activated charcoal and virgin olive oil. In our case, we used repeated doses of virgin olive oil to induce antioxidant activity beside the recommended therapy regimens. Interestingly, the patient presented only mild symptoms of toxicity such as transient metabolic acidosis and hepatic dysfunction.

Case Report of Suicide Attempt Using Zinc Phosphide in Nepal

“…It progressively converts oxyhemoglobin to methemoglobin and Hemi chrome species. The reaction of phosphine with oxyhemoglobin leads to the formation of phosphite and phosphate ions (Altintop &Tatli, 2017). Phosphine mainly affects the cardiovascular, respiratory, gastrointestinal (GI), hepatobiliary, and hematologic systems and causes electrolyte and metabolic abnormalities (Trakulsrichai, Kosanyawat, Atiksawedparit, Sriapha, Tongpoo, Udomsubpayakul, 2017).…”

“…In line with these reports, gastric lavage was done and charcoal was used in our patient. Activated charcoal can decrease the absorption of phosphide particles, which are thought to be responsible for delayed toxic effects (Altintop, 2017). The toxicity of the poisoning is mainly manifested in lungs, liver,kidney and heart (Stephenson, 1967).…”