FATAL ACUTE SELF-POISONING WITH ONE PHOSTOXIN TABLET – A CASE REPORT

Abstract

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.