Brugada Type Ecg Pattern in a Case of Aluminium Phosphide Poisoning

Abstract

ABSTRACT:We are presenting a case which reveals unmasking of Brugada pattern with aluminum phosphide (celphos) ingestion that could most probably be due to hypomagnesaemia caused by the chemical, though its direct toxic effect on cardiac tissue cannot be ruled out. Earlier low levels of magnesium has been shown to precipitate arrhythmias in susceptible individuals and low magnesium levels have been recorded in survivors of sudden death with underlying Brugada syndrome, this is the first case in which celphos induced hypomagnesaemia has unmasked the Brugada pattern in ECG that can increase susceptibility to life threatening arrhythmias. This case opens scope for further research on role of magnesium in celphos poisoning. KEY WORDS: Brugada Pattern, celphos, hypomagesaemia, cardiac tissue, arrhythmias. A CASE REPORT:A 20 years old male presented in the emergency department one hour after ingestion of two tablets of Celphos. He vomited 5 times before admission and was brought in a state of shock and altered sensorium. He did not complain of chest pain, palpitation or breathlessness. His pulse was 145/min, irregularly irregular with pulse deficit of 15 and poor volume. Systolic blood pressure was 80 mmHg and respiratory rate was18/min. His systemic examination did not reveal any positive finding except drowsiness. His routine blood investigations were within normal limits except serum magnesium level of 1.0 mmol/lt and serum potassium of 2.2 mEq/lt. ECG showed typical (type-I phenotype) of Brugada Syndrome with atrial fibrillation (AF) with heart rate of ~145/min. (Fig-1). Gastric lavage was done and patient was given I/V fluids with ionotropic support, I/V magnesium & potassium supplements and hydrocortisone. Patient's condition stabilized with treatment and next day serum electrolytes normalized except serum magnesium which still measured 1.2 mmol/lt & ECG showed persistence of the same pattern. ECHO showed normal cardiac functions. On day 4, serum magnesium level was 2.0 mmol/lt and ECG showed type III Brugada pattern (decreased ST elevation) with regular heart rate of 107/min (Fig--2). ECGs of his mother and brother were normal, however, the provocative tests and genetic testing were declined. Patient had to be discharged on persistent requests.

Fenocopia de Brugada inducida por intoxicación con fosfuro de aluminio: reporte de un caso

“…Previous cases of Brugada phenocopy induced by intoxication by Alp have been reported, none of them in conjunction with acute stress-induced cardiomyopathy. 8,9 The diagnostic criteria for Brugada phenocopy have been established (The first four criteria are mandatory):…”