Successful management of zinc phosphide poisoning

Shakoori, Vahid; Agahi, M Habib; Vasheghani-Farahani, Maryam; Marashi, Sayed Mahdi

doi:10.4103/0972-5229.183907

Cited by 13 publications

(9 citation statements)

References 8 publications

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“…To our knowledge, this is the first documented Hungarian case of intentional ZnP poisoning, where a particularly large dose of ZnP was ingested by the patient and yet, the patient fully recovered. Gastric lavage is recommended for patients if phosphide intoxication took place within a few hours [9] and the use of charcoal is also advised [22], although some sources have suggested the use of potassium permanganate or coconut oil for decontamination [8,23]. In accordance with the previous recommendations, gastric lavage and decontamination with charcoal were carried out in our patient's case as well.…”

Section: Discussionsupporting

confidence: 65%

“…Gastric lavage is recommended for patients if phosphide intoxication took place within a few hours [ 9 ] and the use of charcoal is also advised [ 22 ], although some sources have suggested the use of potassium permanganate or coconut oil for decontamination [ 8 , 23 ]. In accordance with the previous recommendations, gastric lavage and decontamination with charcoal were carried out in our patient’s case as well.…”

Section: Discussionmentioning

confidence: 99%

“…Patients can develop a variety of symptoms, mostly gastrointestinal (68.8%), cardiovascular (22%), and respiratory symptoms (13.8%) [ 7 ]. To date, there is no known antidote for metal phosphide poisoning, although a few treatment options have been documented in case reports, such as the use of coconut oil [ 8 ], castor oil [ 9 ], tranexamic acid [ 10 ], and hemodialysis [ 11 ]. Adequate supportive therapy, often provided within an intensive care unit, is needed for recovery.…”

Section: Introductionmentioning

confidence: 99%

“…Laboratory parameters of the patient at the emergency unit (days[1][2][3][4][5][6][7][8][9][10][11][12][13][14] …”

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confidence: 99%

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Successful management of zinc phosphide poisoning—a Hungarian case

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Laboratory parameters of the patient at the emergency unit (days[1][2][3][4][5][6][7][8][9][10][11][12][13][14] …”

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confidence: 99%

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Successful management of zinc phosphide poisoning—a Hungarian case

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“…published in your journal. [ 1 ] They have reported an 18-year-old patient referring almost 5 h after the ingestion of 20 g of zinc phosphide. Abdominal X-ray showed radiopaque densities throughout the luminal tract which was tried to be treated by the administration of oral castor oil.…”

mentioning

confidence: 99%

RE: Successful management of zinc phosphide poisoning

Zamani

Hassanian‐Moghaddam

2016

Indian Journal of Critical Care Medicine

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Development of detection methods for the diagnosis and analysis of highly toxic metal phosphides: A comprehensive and critical review

Mohammadinejad

Rizi

Oskuee

et al. 2021

Biotech and App Biochem

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Metal phosphides, especially aluminum phosphide, and phosphine (PH 3 ) are widely used as insecticides and rodenticides for protection of grains during process of storage and transportation. The main reason of poisoning with this compound is related to the conscious ingestion of salts or accidental inhalation of PH 3 . So the early and accurate diagnosis of poisoning can significantly help to the effective clinical treatment or recognition of death cause. PH 3 is somewhat unstable due to reaction with oxygen or hemoglobin leading to formation of oxy-acids phosphorous. Here, we critically reviewed the literature introducing the quantitative and qualitative methods for the detection of metal phosphides, PH 3 , and its products. This study obviously demonstrates that during past years, different diagnosis methods have been remarkably progressed. Head-space gas chromatography and confirmatory colorimetric methods have been as the most popular techniques. Also, the gas sensors are a promising method that must be more progressed.

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Successful management of zinc phosphide poisoning

Cited by 13 publications

References 8 publications

Successful management of zinc phosphide poisoning—a Hungarian case

Successful management of zinc phosphide poisoning—a Hungarian case

RE: Successful management of zinc phosphide poisoning

Development of detection methods for the diagnosis and analysis of highly toxic metal phosphides: A comprehensive and critical review

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