Rodencitide poisoning is not uncommon in Malaysia. There are 205 total recorded case from 2006-2016 which made 0.5% of total poisoning in Malaysia due to rodenticide. Common rodenticides are Coumadin based and Zinc Phosphide. Zinc Phosphide powder reacts with water and even more vigorously with gastric juices to release phosphine gas. The most common clinical presentations were gastrointestinal (profuse vomiting 100% and abdominal pain 100%), cardiovascular (palpitation and sweating 80%, hypotension and shock 40%), and respiratory (dyspnoea and tachypnoea 75%). Mortality with zinc phosphide poisoning is high with ingestions exceeding 1gm. We would like to report a 39-year-old Chinese gentleman that ingested 32 grams of Zinc Phosphide and presented to one of the district hospital in Melaka. He developed severe cardiovascular toxicity and despite our best effort succumbed to his death. We would like to share the difficulty in managing such case including risk posed by healthcare personnel involved.
Zinc Phosphide, Rodenticide, Phosphine, Personal Protective Equipment, Self-combustion.
2.Shadnia S. Fumigants, Chapter 111. In: Hoffman R,Howland MA, Lewin NA, Nelson LS, Goldfrank LR,editors. Goldfrank’s toxicologic emergencies. 10th ed.New York: McGraw Hill Education; 2015. p. 1381–8.
3.Chugh SN, Aggarwal HK, Mahajan SK. Zinc phosphide intoxication symptoms: analysis of 20 cases. International journal of clinical pharmacology and therapeutics. 1998;36(7):406-7.
4.Meena MC, Mittal S, Rani Y. Fatal aluminium phosphide poisoning. Interdisciplinary Toxicology. 2015;8(2):65-7.
5. Mital HS, Mehrotra TN, Dwivedi KK, et al. A study of aluminium phosphide poisoning with special reference to silver nitrate test. J Assoc Physcians India.1992;40:473–4.
6.Maitai CK, Njoroge DK, Abuga KO, et al. Investigation of possible antidotal effects of activated charcoal, sodium bicarbonate, hydrogen peroxide and potassium permanganate in zinc phosphide poisoning. East Central Afr J Phram Sci. 2002;5:38–41.
7.Pajoumand A, Jalali N, Abdollahi M, et al. Survival after acute aluminium phosphide poisoning. J Pharm Pract Res. 2002;32:297–9
8.Goswami L, Bindal M, Sen P, et al. Fat and oil inhibit release of phosphine from aluminium phosphide-its clinical implications. Indian J Exp Biol. 1994;32:647–9
9.Shadnia S, Rahimi M, Pajoumand A, et al. Successful treatment of acute aluminium phosphide poisoning, possible benefit of coconut oil. Hum Exp Toxicol. 2005;24:215–8
10.Gurjar M, Baronia AK, Azim A, et al. Managing aluminium phosphide poisoning. J Emerg Trauma Shock. 2011;4:378–84
11.Chugh SN, Kumar P, Sharma A, et al. Magnesium status and magnesium sulphate therapy in acute aluminium phosphide intoxication. Magnes Res. 1994;7:289–94.
12.Chugh SN, Kumar P, Aggarwal HK, et al. Efficacy of magnesium sulphate in acute aluminium phosphide poisoning. J Assoc Physicians India. 1994;42:373–5.
13. Tehrani H, Halvaie Z, Shadnia S, Soltaninejad K, Abdollahi M. Protective effects of N-acetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning. Clin Toxicol (Phila) 2013;51:23-8
14. Taghaddosinejad F, Farzaneh E, Ghazanfari-Nasrabad M, Eizadi-Mood N, Hajihosseini M, Mehrpour O, et al. The effect of N-acetyl cysteine (NAC) on aluminum phosphide poisoning inducing cardiovascular toxicity: A case-control study. Springerplus 2016;5:1948
15. Chaudhry D, Rai AS. N-acetyl cysteine in aluminum phosphide poisoning: Myth or hope. Indian J Crit Care Med 2014;18:646-7
16. Oghabian Z, Mehrpour O. Treatment of aluminium phosphide poisoning with a combination of intravenous glucagon, digoxin and antioxidant agents. Sultan Qaboos Univ Med J 2016;16:e352-5
17. Agarwal A, Robo R, Jain N, Gutch N, Consil S, Kumar S. Oxidative stress determined through the levels of antioxidant enzymes and the effect of N-acetyl cysteine in aluminum phosphide poisoning. Indian J Crit Care Med 2014;18:668-73
18. Hassanian Moghaddam H, Pajoumand A. Two years epidemiological survey of aluminium phosphide poisoning.Iranian J Toxicol. 2007;1:1–9.
19. Shadania S, Soltaninejad K. Spontaneous ignition due to intentional acute aluminium phosphide poisoning. J Emerg Med. 2011;40:179–81
20. Wahab A, Rabbani MU, Wahab S, et al. Spontaneous self ignition in case of acute aluminium phosphide poisoning. Am J Emerg Med. 2009;27:752.e5–6.
21. Yadav J, Ahlawat BK, Dubey BP, et al. Spontaneous ignition in case of celphos poisoning. Am J Forensic Med Pathol. 2007;28:353–5
22. Christophers AJ, Singh S, Goddard DG. Dangerous bodies: a case of fatal aluminium phosphide poisoning. MJA. 2002;176(8):403