Zinc phosphide toxicity with a trial of tranexamic acid in its management

Abstract

Zinc phosphide is a highly effective rodenticide used widely to protect grain in stores and domestically to kill rodents. Acute poisoning may be direct by ingestion or indirect through accidental inhalation of phosphine gas generated during its use. This study aims to identify the patterns of intoxication with zinc phosphide among Egyptian patients admitted to the National Egyptian Center of Clinical and Environmental Toxicological Research (NECTR); to study the role of antifibrinolytics in management of zinc phosphide toxicity; and to publish the results of the study, which include recommendations for action towards planning prevention and education programs. The study provides descriptive data and analysis of 188 cases admitted to the NECTR with acute zinc phosphide poisoning over a period of 22 months. Results show that poisoning is more common among females (60.6% of cases) than males (39.4%); the mean age is nearly 21 years old. The most common cause of poisoning is suicidal attempts (83.6%) followed by accidental exposure (16.4%). The most common causative factors that lead to self-poisoning are marital disharmony, economic hardship, social problems and scolding from other family members. Signs and symptoms of toxicity include gastrointestinal disturbances, respiratory compromise and changes in mental status. Other features include disseminated intravascular coagulation, hepatic and renal impairment. Metabolic disturbances had been reported. Death can result immediately due to pulmonary edema or delayed due to cardiotoxicity. Patients must be admitted to hospital and observed for at least 3 days. Symptomatic and supportive care is the mainstay of therapy. Zinc phosphide poisoning requires gastric lavage with excessive sodium bicarbonate solution. Tranexamic acid -an antifibrinolytic

Assessment of the Role of Total Antioxidant Capacity and Troponin I as Possible Predictors for Phosphides -Induced Cardiotoxicity

“…The mean age of studied patients was 24.67±11.29 years. This is in accordance with several studies reported that acute phosphide poisoning was common in young adults (El Naggar and El Mahdy., 2011;Soltaninejad et al, 2012 andElghany et al, 2018).This was explained by exposure of this age group to unemployment and financial instability (Chandrakant et al, 2015;Dadpour et al, 2016). On the other hand, a study in India by Gupta et al (2011) found that accidental ALP ingestion was common in children due to illiteracy and its easy availability in the Indian agricultural community.…”

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

“…Acute phosphide poisoning (zinc or aluminum) produced PH 3 within 30 min of ingestion in the body, which is extremely toxic and highly irritating to the respiratory tract and also caused severe systemic toxicity. Death may result in less than 6 h due to pulmonary edema, cardiotoxicity, refractory hypotension, cardiogenic shock, and multiorgan failure [13,14]. Occasionally, there may be a delay in the onset of symptoms by 3 days and therefore, it is suggested that the patient should be placed under observation for at least 72 h after the ingestion of phosphine containing products.…”

Evaluation of Potential Oxidative Stress in Egyptian Patients with Acute Zinc Phosphide Poisoning and the Role of Vitamin C

“…(1) Due to its low price and easy availability, phosphide is emerging as a common self-poisoning agent in Egypt. (2) Reported morbidity and mortality rate due to phosphide poisoning is too high, especially in developing countries and in Egypt. (2,3) Acute poisoning with zinc phosphides may occur either through direct ingestion of the salts themselves or indirect inhalation of the phosphine gas generated on exposure to moisture.…”

“…(2) Reported morbidity and mortality rate due to phosphide poisoning is too high, especially in developing countries and in Egypt. (2,3) Acute poisoning with zinc phosphides may occur either through direct ingestion of the salts themselves or indirect inhalation of the phosphine gas generated on exposure to moisture. (1) When zinc phosphide comes in contact with water, moisture in the air, or hydrochloric acid in the stomach, a chemical reaction starts releasing phosphine gas which is rapidly absorbed throughout the gastrointestinal tract and the lungs.…”