A Rare Type of Suicide Attempt in East Turkey: Acute Zinc Phosphide Poisoning

Abstract

Objective: The purpose of this study was to predict the clinic and demographic profile of patients who attempt suicide by poisoning with zinc phosphide. Material and Methods: All cases presenting to the ED from January 1 st 2009 to April 30 th 2011 due to Acute Zinc Phosphide Poisoning were retrospectively reviewed. Results: All cases had taken the pharmaceutical product in an attempt to commit suicide. The average age of the cases was 25.4 years. Sixteen of the cases were female (76%), and five (24%) were male; all of the cases who died were female. In terms of marital status, 4 (19%) of the cases were single or unmarried. A total of 8 (38%) cases were unconscious and had low pH levels (<7.35), and 9 (43%) cases had signs of shock, such as hypotension and tachycardia. The average level of bicarbonate in the arterial blood gas of the cases was 23.20 mmol/L and the average amount of time (admission time) taken to bring the patients from the place where they were poisoned to the ED was 2.40 hours. According to the autopsy results of the dead patients, there were findings of liver congestion, liver necrosis, pancreatic edema and hemorrhagic points together with inflammation in the kidneys. Conclusion: Although it is a rare form of suicide attempt, the mortality rate for patients with zinc phosphide poisoning is high. Early resuscitation can have positive effects on morbidity and mortality. Patients who suffer from zinc phosphide poisoning must be monitored under intensive care conditions. (JAEM 2013; 12: 76-9 Olguların yaş ortalaması 25,4 yıl idi. Olguların 16'sı (%76) bayan ve 5'i (%24) erkek idi; ölen olguların hepsi bayan idi. Dört (%19) olgu bekar veya yanlızdı. Sekiz (%38) olguda şuur kaybı ve düşük pH (<7,35) düzeyi ve 9 (%43) olguda hipotansiyon ve taşikardi gibi şok bulguları vardı. Ortalama bikarbonat düzeyi 23,20 mmol/L ve zehirlenmenin olduğu yer ile acil servise kabul edilinceye kadar geçen zaman ortalaması 2,40 saat idi. Otopsi sonuçlarına göre ölen olgularda,karaciğer konjesyonu,karaciğer nekrozu,pancreas ödemi ve böb-reklerde kanama odakları ile beraber enflamasyon vardı. Sonuç: Nadir bir özkıyım şekli olmasına rağmen, çinko fosfid zehirlenmesi olan hastalar için mortalite oranı yüksektir. Erken müdahale mortalite ve morbiditeye olumlu etki yapabilir. Çinko fosfid zehirlenmesine maruz kalan hastaların yoğun bakım şartlarında takibi yapılmalıdır. (JAEM 2013; 12: 76-9) Anahtar kelimeler: Özkıyım girişimi, çinko fosfid, zehirlenme, acil servis

Acute on chronic liver failure presentation of zinc phosphide poisoning: a concept elucidating case report

“…8 A study from turkey found that autopsy revealed congestion and several necrotic areas in liver. 9 There is no antidote for poisoning with metal phosphides, such as zinc phosphide. A Turkish study showed 27 % mortality and the rate of mortality was twice as high in patients with high levels of liver enzymes as compared to patients with normal liver enzyme levels.…”

Aspartate Aminotransferase Level as a Prognostic Marker in Acute Zinc Phosphide Poisoning

“…This is just an estimate as most cases of poisoning actually go unreported, particularly in Third World countries (1). Self-poisoning has reached epidemic proportions and has become a major public health issue in parts of the developing world (2,3). Based on the limited data, it is estimated that 220,000 deaths occur worldwide annually, and majority of these deaths are intentional (4).…”

“…Zinc phosphide is a dark-grey, crystalline compound and is a highly effective rodenticide that is commonly used in the agricultural sector by mixing with food as bait (3). Phosphides are normally found as powders or pellets, usually as zinc or aluminum phosphide (Zn 3 P 2 and AlP); calcium and magnesium phosphide salts are also available.…”

“…Respiratory complaints could be tachypnea, dyspnea, and coughing and can even progress to acute lung injury over days (3,10). Also non-cardiogenic pulmonary edema may develop later and should be managed aggressively by positive end-expiratory pressure ventilation (11).…”

Çinko Fosfür İçeren Fare Zehiri ile Özkıyım Girişimi Olgu Sunumu

“…Oral alımında mide asidi ile reaksiyona girerek fosfin gazına bağlı akut zehirlenmelere yol açar (1,2). Spesifik antidotunun olmaması ve yüksek mortalitesi nedeniyle bu tür zehirlenmeler yoğun bakım ünitesinde takip edilmelidir (3).…”