Citation

Bilics G, Héger J, Pozsgai, Bajzik G, Nagy C, Somoskövi C, Varga C. Int. J. Emerg. Med. 2020; 13(1).

Copyright

(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1186/s12245-020-00307-8

PMID

unavailable

Abstract

BACKGROUND: Zinc phosphide (ZnP) is the basic component of several insecticides easily accessible worldwide. Intentional or accidental intoxication may lead to severe complications and multiple organ failure, resulting in high mortality. No known antidote is currently available. The iron-chelation and the antioxidative effects are well-known features of alpha-lipoic acid (ALA), although its use in the treatment of ZnP poisoning has not been documented previously. We describe the case of a patient with serious ZnP poisoning with multiple organ failure, where ALA was also included in the patient's supportive therapy. Case presentation: A 65-year-old man ingested 125 g of Arvalin® (containing 5 g ZnP) and presented to the Emergency Department, with respiratory insufficiency and decreased consciousness. He developed hypokalemia, hypocalcemia, low white blood cell count, elevated C-reactive protein level, mixed acidosis, hepatic and kidney damage, thickening of the jejunal wall, and lung atelectasis, which served as a basis for the ensuing bacterial pneumonia. Antibiotics and adequate supportive therapy were provided. Laboratory tests indicated liver damage (slightly increased liver enzymes, low pseudocholinesterase levels; 706 U/L on day 2), possibly caused by the patient's chronic alcoholism or the ZnP poison itself, therefore, hepatoprotective agents, ALA (Thiogamma Turbo-Set®) with N-acetylcysteine were administered for six consecutive days. Pseudocholinesterase values increased sixfold until the end of the second week of care. Fifteen days after admission, the patient was relocated to the department of psychiatry with stable vital functions, clear consciousness, declining inflammatory markers, and improved liver function. He was discharged 1 month later, fully recovered.

CONCLUSIONS: Our case is the first documented voluntary and severe ZnP poisoning in Hungary. Our patient developed multiple organ failure and atelectasis, possibly resulting in the observed respiratory infection. The development of bacterial pneumonia highlighted the dangers of phosphine-induced atelectasis. The use of ALA in our patient's case, as an antioxidant and agent for metal chelation, suggested that this agent could be a promising tool in the prevention and treatment of ZnP-induced hepatic damage. © 2020 The Author(s).

Language: en

Keywords

human; male; Poisoning; multiple organ failure; aged; Hungary; alcoholism; case report; psychotherapy; abdominal pain; depression; suicide attempt; C reactive protein; disease severity; inflammation; intoxication; vomiting; mental disease; clinical article; paroxetine; tachycardia; unclassified drug; priority journal; bleeding; alprazolam; emergency ward; activated carbon; insecticide; potassium chloride; electrolyte; drug urine level; drug efficacy; benzodiazepine; disease exacerbation; urinalysis; fever; artificial ventilation; heart rate; agitation; hypocalcemia; Caucasian; clonazepam; acetylcysteine; antibiotic agent; liver injury; endotracheal intubation; Glasgow coma scale; cholinesterase; creatinine; leukocyte count; respiratory failure; bronchoscopy; midazolam; gluconate calcium; dyspnea; methylprednisolone; Pneumonia; blood pressure; furosemide; thorax radiography; treatment response; ciprofloxacin; upper gastrointestinal bleeding; oxygen saturation; oxygen therapy; extubation; heart ventricle tachycardia; kidney injury; liver enzyme; Article; crystalloid; single drug dose; hypokalemia; consciousness disorder; ceftriaxone; biological marker; arterial gas; antibiotic sensitivity; bacteremia; tiapride; mucosa inflammation; central venous catheterization; respiratory tract infection; anion gap; abnormal respiratory sound; blood culture; wheezing; acidosis; bacterial pneumonia; atelectasis; lung infiltrate; glomerulus filtration rate; potassium ion; calcium ion; neutral insulin; Zinc phosphide; N-acetylcysteine; jejunum; thioctic acid; clinical outcome; zinc phosphide; Pseudocholinesterase; x-ray computed tomography; Acinetobacter; Alpha-lipoic acid; bacterial count; Dihydrolipoic acid; dull percussion note; intestine wall; isolyte; lung alveolus; moderate renal impairment; polystyrenesulfonic acid; sputum; stereofundin b; sterofundin; thiogamma turboset; trachea stoma; tranexamic acid