Sudden Cardiac Arrest in an Asymptomatic Zinc Phosphide-Poisoned Patient: A Case Report

Suicide attempt using zinc phosphide rodenticide: A case report and literature review

“…Although PH 3 can cause ventricular tachycardia, ventricular fibrillation, ST‐segment elevation/depression, and a wide QRS complex, cardiovascular damage due to ZnP toxicity can lead to early death without any changes in ECG, 8 as seen in our patient (CPK = 6895 U/L).…”

“…Zinc phosphide is a low‐cost substance that people with poor socioeconomic status in Asia have easy access to, and Iran is no exception 4,8–10 . The mortality rate of phosphide toxicity due to suicidal intentions is estimated at about 2.6% in Iran 11 .…”

“…Most patients with PH 3 intoxication are referred to hospital with common signs and symptoms, including N/V, retrosternal burning, metabolic acidosis, hypotension, hypoglycemia, delirium, and tonic‐clonic seizures, which can lead to severe clinical findings such as circulatory collapse, dysrhythmias, congestive heart failure, pulmonary edema, acute liver, and renal failure that can cause early death 8,11 . Our patient was presented to the hospital with N/V, hypotension, and sinus tachycardia on ECG.…”

“…As it was stated in many papers, there are several mechanisms involved in PH 3 poisoning, substantially inhibition of cytochrome C oxidase and oxidative respiration 4,7 . The following mechanisms have also been described for ZnP toxicity: anticholinesterase activity leading to deterioration of oxyhemoglobin molecules, inhibition of catalase and peroxidase activity leading to lipid peroxidation (LPO), DNA damage, and alteration in mitochondrial morphology and oxidative respiration by inducing hypoxia in the liver 1,8 …”

“…PH 3 can affect the cardiovascular, respiratory, hepatobiliary, and hematologic systems, and also the gastrointestinal (GI) tract. Also, electrolyte and metabolic abnormalities, nephrological and neurological defects, and ultimately multi‐organ failure have all been recognized with phosphide poisoning 2,4,7,8 …”