Citation

Katwal S, Malbul K, Mandal SK, Kc S, Alam MZ, Karki P, Pant C. Ann. Med. Surg. (Lond.) 2021; 70.

Copyright

(Copyright © 2021, Surgical Associates, Publisher Elsevier Publishing)

DOI

10.1016/j.amsu.2021.102868

PMID

unavailable

Abstract

INTRODUCTION: and Importance: Aluminum phosphide (ALP) is a commonly available pesticide in agricultural countries like Nepal. Upon ingestion, this releases highly toxic phosphine gas in the gastrointestinal tract when it comes in contact with humidity. This leads to refractory shock, metabolic acidosis, cardiac arrhythmia, renal failure, and hepato-biliary impairment. Case presentation: We present a successfully managed case of a 17-year-old girl who ingested 6 g (2 tablets) of ALP tablets with suicidal intent. Although the mortality has been reported as 70-100% with mere ingestion of 150-500 mg of ALP, this case survived even after developing severe metabolic acidosis, acute renal failure, refractory shock, and ventricular tachycardia. Clinical discussion: ALP poisoning is most often lethal. However, there is an emerging evidence of successful use of various drugs such as magnesium sulfate, trimetazidine, and other interventions such as intra-aortic balloon pump and extra corporeal membrane oxygenation in case of ALP poisoning.

CONCLUSION: Owing to the unavailability of an effective antidote of ALP to date, we emphasize early initiation of supportive management, intensive monitoring, and potential role of membrane stabilizers like magnesium sulfate, and cardio-protective agents like trimetazidine, N-Acetyl cysteine, thiamine, vitamin C, and hydrocortisone in decreasing the likelihood of fatal outcome. © 2021 The Authors

Language: en

Keywords

adolescent; human; suicide; Suicide; female; Poisoning; case report; hemodialysis; aluminum phosphide; Case report; intoxication; vomiting; clinical article; stomach lavage; intensive care unit; noradrenalin; ingestion; poison; follow up; hemodynamics; acute kidney failure; amiodarone; artificial ventilation; heart rate; heart arrhythmia; alanine aminotransferase; aspartate aminotransferase; clonazepam; bicarbonate; creatinine blood level; magnesium sulfate; metabolic acidosis; Aluminum phosphide; blood pressure; furosemide; oxygen saturation; heart ventricle tachycardia; Article; abdominal discomfort; bilirubin; hypokinesia; liver function test; heart ejection fraction; breathing rate; hyperphosphatemia; pleura effusion; electrolyte balance; alkaline phosphatase; mitral valve regurgitation; trimetazidine; hypermagnesemia; extracorporeal oxygenation; heart muscle contractility; torasemide; hospital mortality; Refractory shock