Abstract
Aluminum phosphide is a common suicidal agent in an agrarian country like India. Toxicity is mostly due to the liberation of phosphine gas, which non-competitively inhibits cytochrome oxidase in the mitochondria causing cell hypoxia. It can involve almost any organ in the body, but the most common is cardiovascular system. Various cardiovascular manifestations are hypotension, myocarditis, pericarditis, congestive heart failure, various ECG changes like myocardial infarction, conduction abnormalities, various arrhythmias, and very rarely unmasking of the Brugada pattern. Here we are presenting a case in which the patient developed unmasking of the Brugada pattern in ECG, and gradually he improved symptomatically and ECG wise with conservative treatment. As unmasking of the Brugada pattern in ECG can lead to life-threatening arrhythmias, one has to be cautious and keep this in mind while dealing with a case of aluminum phosphide poisoning.
Highlights
Aluminum phosphide is widely used as a fumigant for stored grains to control rodents and insect pests
The patient developed coved ST-segment elevation in right precordial leads with right bundle branch block (RBBB) pattern, typical of Brugada pattern in ECG, which is dangerous, because it can lead to ventricular fibrillation and death
Various ECG abnormalities have been mentioned in the literature because of aluminum phosphide poisoning; induction of Brugada pattern is sparse in the literature
Summary
Aluminum phosphide is widely used as a fumigant for stored grains to control rodents and insect pests. A 19-year-old young male patient admitted to the emergency department after eight hours of consumption of aluminum phosphide poison He was initially treated at a local hospital with potassium permanganate stomach wash, i.v. fluids, and pantoprazole injection and referred to our hospital. ECG was advised, which revealed PR 119/min, corrected QT interval (QTc) 434 msec, coved ST-segment elevation of more than 5 mm in lead V1 to V3, with incomplete RBBB morphology, and T-wave inversion in V2 and V3, suggestive of type 1 Brugada pattern (Figure 1). ECG showing pulse rate (PR) 119/min, corrected QT interval (QTc) 434 msec, coved ST-segment elevation of more than 5 mm in lead V1 to V3, with incomplete right bundle branch block (RBBB) morphology, and T-wave inversion in V2 and V3, suggestive of type 1 Brugada pattern. ECG showing pulse rate (PR) 105/min, corrected QT interval (QTc) 398 msec, ST-segment elevation became isoelectric in lead V1 and decreased to 1 mm in lead V2-V3, and T-wave inversion in V1 to V3
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