Abstract
BackgroundAluminum phosphide is a very common suicide agent in developing countries like Nepal. Due to the unavailability of a specific antidote, mortality is very high because the phosphine molecule that is formed leads to inhibition of the cytochrome oxidase enzyme system in mitochondria. Extracorporeal membrane oxygenation provides life-saving support to the cardiovascular and respiratory systems until the deadly poison is eliminated from the body.Case presentationWe encountered one case of 67-year-old Asian woman, a known case of major depressive disorder, who presented to our center with suicidal ingestion of aluminum phosphide with cardiovascular and respiratory dysfunction. On presentation in our emergency room, she had an ejection fraction of 20% and had to be immediately intubated for respiratory failure. Based on the evidence of almost 100% mortality with aluminum phosphide poisoning, extracorporeal membrane oxygenation was initiated in our intensive care unit. Her general condition and hemodynamics gradually improved over the course of 2 days and she was weaned from extracorporeal membrane oxygenation and ventilator by post-extracorporeal membrane oxygenation days 3 and 4, respectively. After psychiatric evaluation and establishment of normal vital parameters, she was moved out of intensive care unit on post-extracorporeal membrane oxygenation day 6 and discharged to home on post-extracorporeal membrane oxygenation day 10.ConclusionsAlthough this seems to be a small step in terms of global perspective, it is a giant stride for a developing country. The management of reversible but severe cardiac and respiratory failure certainly opens up newer scopes where we can ensure a quality health care service being made accessible even to the most underprivileged people.
Highlights
ConclusionsThis seems to be a small step in terms of global perspective, it is a giant stride for a developing country
Aluminum phosphide is a very common suicide agent in developing countries like Nepal
Conclusions: this seems to be a small step in terms of global perspective, it is a giant stride for a developing country
Summary
The use of ECMO in AlP poisoning in other parts of the world is not new, this is a new experiment for us. ECMO was never used for this purpose before in Nepal which we believe was due to hesitation because of fear about its success. In a country where considerable numbers of people die each year because of the result of their momentary decision to end their lives and who, otherwise, would have lived a productive life, there seems to be a possibility to reverse those reversible changes; this success surely opens doors to more opportunities.
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