Successful Management of an Aluminum Phosphide Poisoned Patient Following Ventricular Tachycardia

Abstract

Aluminum Phosphide (ALP) poisoning is regarded as fatal; however, it is commonly used in developing countries. In some countries, such as India and Iran, it is still being used to protect grain against pests at home. As yet, no known antidote is reported to be effective against ALP poisoning. ALP acts through blockage of cell respiration, alteration of cell permeability, and induction of oxidative stress. Some factors can worsen the prognosis of its intoxication, which include hyperglycemia on admission, ingestion of fresh tablets, cardiac abnormality, especially Ventricular Tachycardia (VT), severe metabolic acidosis, cardiogenic shock and other types of shocks, electrolyte disturbances, end-organ damage, and a need for mechanical ventilation. ALP kills its victims by induction of multi-organ failure. In this study, we controlled the patient’s VT using MgSO4, electric shock, amiodarone, and lidocaine. We also encountered the cardiogenic shock using norepinephrine, High-Dose Insulin (HDI), antioxidants, sodium bicarbonate, and normal saline. Moreover, myocardial ischemia, recurrent VTs, and adverse cardiac effects were protected via tight control of magnesium and other electrolytes.