Aluminum phosphide, known as "rice tablet" (RT), is a common cause of suicide in adult women in Iran, with a high rate of lethal outcome. We report a patient with RT toxicity, with a complex syndrome of hepatic failure, renal failure, Brugada electrocardiography (ECG) patterns, and pleuropericardial effusion. The patient received conventional management with fluid therapy, gastric washing, activated charcoal followed by intra-aortic balloon pump insertion, inotropic drugs support, and mechanical ventilation. The unique features of our case are related to a combination of multiorgan failure with Brugada atypical ECG patterns and pleuropericardial effusion. Among the aforementioned complications, pleuropericardial effusion, ascites, and Brugada syndrome are exceedingly rare events. The patient was treated with high-dose inotropic drugs and intra-aortic balloon pump insertion. Despite tremendous management of metabolic acidosis, all efforts failed, and the patient died with sudden cardiac arrest.
References
1.
Lemoine TJ, Schoolman K, Jackman G, Vernon DD. Unintentional Fatal Phosphine Gas Poisoning of a Family. Pediatric Emergency Care. 2011;27(9):869–71.
2.
O’Malley M, Fong H, Sánchez ME, Roisman R, Nonato Y, Mehler L. Inhalation of Phosphine Gas Following a Fire Associated with Fumigation of Processed Pistachio Nuts. Journal of Agromedicine. 2013;18(2):151–73.
3.
Rodenberg HD, Chang CC, Watson WA. Zinc phosphide ingestion: a case report and review. Vet Hum Toxicol. 1989;31(6):559–62.
4.
Shadnia S, Rahimi M, Pajoumand A, Rasouli MH, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Human & Experimental Toxicology. 2005;24(4):215–8.
5.
Misra UK, Tripathi AK, Pandey R, Bhargwa B. Acute Phosphine Poisoning following Ingestion of Aluminium Phosphide. Human Toxicology. 1988;7(4):343–5.
6.
Mehra A, Sharma N. ECMO: A ray of hope for young suicide victims with acute aluminum phosphide poisoning and shock. Indian Heart Journal. 2016;68(3):256–7.
7.
Musshoff F, Preuss J, Lignitz E, Madea B. A gas chromatographic analysis of phosphine in biological material in a case of suicide. Forensic Science International. 2008;177(2–3):e35–8.
8.
Anger F, Paysant F, Brousse F, Normand IL, Develay P, Galliard Y, et al. Fatal Aluminum Phosphide Poisoning. Journal of Analytical Toxicology. 2000;24(2):90–2.
9.
Yadav J, Athawal BK, Dubey BP, Yadav VK. Spontaneous Ignition in Case of Celphos Poisoning. American Journal of Forensic Medicine & Pathology. 2007;28(4):353–5.
10.
Anand R, Binukumar BK, Gill KD. Aluminum phosphide poisoning: an unsolved riddle. Journal of Applied Toxicology. 2011;31(6):499–505.
11.
Harger RN, Spolyar LW. Toxicity of phosphine, with a possible fatality from this poison. AMA Arch Ind Health. 1958;18(6):497–504.
12.
Sudakin DL. Occupational exposure to aluminium phosphide and phosphine gas? A suspected case report and review of the literature. Human & Experimental Toxicology. 2005;24(1):27–33.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
