Reversible myocardial injury associated with aluminum phosphide poisoning

Abstract

Background. Aluminum phosphide poisoning has high mortality resulting from cardiac impairment and hemodynamic disorders. We report two cases of aluminum phosphide associated with reversible myocardial injury. Cases Reports. A 19-year-old woman and a 28-year-old man were admitted to hospital following ingestion of aluminum phosphide. The clinical course was characterized by the development of a shock syndrome requiring the use of vasoactive amines in the woman. However, the arterial hypotension in the man was improved by fluid filling and vasoactive drugs. The myocardial injury was objectively documented in both cases. The electrocardiogram showed ST-segment elevations and diffusely abnormal repolarization. The plasma concentrations of cardiac enzymes were elevated. In the second case, echocardiography showed similar myocardial involvement with left ventricular hypokinesis (left ventricle ejection fraction 30%). In both cases, there was progressive improvement in hemodynamic status, cardiac traces, and biochemical values. A simultaneous improvement was observed in echocardiogram of the second case (left ventricle ejection fraction increased to 50%). Conclusion. Reversible myocardial injury following aluminum phosphide poisoning has been described in few cases. We objectively documented progressive clinical and electrical improvement in two cases.

Response to “Blood Levels of Methemoglobin in Patients with Aluminum Phosphide Poisoning and its Correlation with Patient’s Outcome”

“…The first point has previously been pointed out and illustrated by two other authors [9,10]. Also, if the patient vomits immediately after the ingestion due to the unpleasant taste and odor of the tablet, he/she will possibly survive [3,11,12]. Thanks for this interesting study.…”

Chemical Reaction between Boric Acid and Phosphine Indicates Boric Acid as an Antidote for Aluminium Phosphide Poisoning

“…1 AlP is a multiorgan poison which has toxic effects on the cardiovascular, respiratory, hepatic and gastrointestinal systems and induces acid-base disturbances. 1,[5][6][7][8][9] Myocardial damage is reported to be the primary cause of death in AlP poisoning. 10,11 AlP poisoning is more prevalent in Iran and India.…”

Rice tablet: An overview to common material in Iran

“…There are any reports about survival of patients after cardiogenic shock. 14 In autopsy of these patients, edema of myocardial fibers, heart congestion, vacuolization and focal necrosis of myosites, and myocardial cell infiltration are significant findings. Although in all death patients especially who death earlier than 12 hours was not observed.…”

“…14,19 Pulmonary symptoms of patients are including pulmonary edema, Ronkei, tachypnea, dyspnea, and crepitation. Pulmonary edema is common within 4-8 hours after poisoning, and its pulmonary or cardiac origin is not clear.…”