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    FATAL ACUTE SELF-POISONING WITH ONE PHOSTOXIN TABLET – A CASE REPORT
    (2023-05)
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    Niko Bekarovski
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    Andon Chibishev
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    Aluminum phosphide (AlP) is well known as an effective pesticide for grain preservation, but also as a suicidal agent due to its high human toxicity. Phosphine gas (PH3), which is released in contact with stomach acid, is responsible for systemic toxicity and high mortality. We report the first case of severe intentional AlP poisoning treated in our clinic with a fatal outcome and review the therapeutic modalities. A 35-year-old woman with a history of epilepsy was admitted to the University Clinic for Toxicology two hours after the intentional ingestion of a phostoxin (AlP) tablet. She presented with vomiting, abdominal pain, leukocytosis, ECG changes (prolonged PT interval, inverted T waves in D3, AVF, and left precordial leads), hypotension (80/40 mmHg, heart rate 120/min) and respiratory failure, after which she was transferred to the ICU. Signs of hepatic lesion, rhabdomyolysis, renal failure and metabolic acidosis (pO2 9.6 kPa, pCO2 4.14 kPa, pH 7.15, bicarbonate 11 mmol/L, BE -15) were noted. Despite the application of mechanical ventilation, fluid supplementation and inotropic support, hemodynamic instability worsened. Cardiopulmonary resuscitation was performed three times, but unfortunately the patient had a fatal outcome on the fourth day of hospitalization. Freshly opened phostoxin tablets (3 g) are very toxic, and the dose of AlP they contain is sufficient to cause progressive life-threatening symptoms and a fatal outcome. In the absence of antidote, consensus on treatment and elucidated mechanisms of toxicity, the key to treatment is rapid decontamination and initiation of resuscitation measures.
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    FATAL ACUTE ALIMINIUM PHOSPHIDE POISONING - CASE REPORT AND LITERATURE REVIEW WITH REFERENCE TO CURRENT TREATMENT PROTOCOLS AND OUTCOME
    (Tbilisi State Medical University, 2021-11)
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    Kostadinovski K
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    Aluminum phosphide (AlP) has been known for more than 80 years as an effective pesticide for grain protection, but also as a suicidal agent used for human self-poisoning. Phosphine gas released in contact with stomach acid after oral ingestion of AlP is responsible for its toxicity. The poison affects all systems, so the mortality rate is quite high, especially after deliberate ingestions. We report the first case of severe AlP poisoning seen in our institution with a fatal outcome and furthermore, we present literature review on existing and newer treatment options. A 35-year-old woman with a history of epilepsy was admitted to the University Clinic for Toxicology in Skopje two hours after deliberate ingestion of one tablet of phostoxin (AlP). The first signs of poisoning were vomiting and abdominal pain, leukocytosis, prolonged PT, as well as inverted T waves in D3, AVF and left precordial leads on ECG. After developing respiratory failure and hypotension she was transferred to the intensive care unit (ICU). Her blood pressure was 80/40 mmHg, pulse rate 120/min. Laboratory findings showed signs of hepatic lesion, rhabdomyolysis and renal failure (AST 2267.42 U/L, ALT 2102.26 U/L, CPK 1334.81U/L, blood urea nitrogen 23.03 mmol/L, creatinine 211.9 µmol/L). Arterial blood gas analyses showed metabolic acidosis (pO2 9.6 kPa, pCO2 4.14 kPa, pH 7.15, bicarbonate 11 mmol/L, BE -15). The patient was placed on mechanical ventilation. Despite fluid supplementation, intensive therapy and inotropic support, hemodynamic instability worsened and cardiopulmonary resuscitation was performed three times. Unfortunately, the patient had a fatal outcome on the fourth day of intoxication. Solid formulations of AlP are very toxic. One tablet of phostoxin containing 3 grams of AlP is sufficient for the progression of life-threatening symptoms and fatal outcome. In the absence of antidote and elucidated mechanisms of toxicity, the key to treatment is rapid decontamination and initiation of resuscitation measures.