PP036 Acute ingestion of zinc phosphide: Garlicky gas that stunned the heart

Abstract

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.