Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning

Nasim Zamani,Ahmad Amouzeshi,Shahram Amini,Robert S. Hoffman,Omid Mehrpour,Bita Dadpour,Zohreh Oghabian

doi:10.2478/10004-1254-65-2014-2393

Abstract

Aluminium phosphide (AlP) is a highly toxic pesticide that inhibits cytochrome oxidase c and causes oxidative stress. Death results from refractory cardiogenic shock due to myocardial dysfunction. There is very little information regarding extracorporeal life support in severe AlP poisoning. Although several therapies are available, none are curative. We report on the use of an intra-aortic balloon pump (IABP) in a 24-year-old woman brought to our hospital after an intentional ingestion of a tablet of AlP (3 g), which caused refractory AlP-induced cardiogenic shock and acute respiratory distress syndrome (ARDS). The patient underwent gastric lavage with potassium permanganate, received sodium bicarbonate intravenously, and was admitted to the intensive care unit. Echocardiography at 36 h post ingestion showed a left ventricular ejection fraction (LVEF) of <20 %. An IABP was inserted and the patient’s vital signs stabilised. After eight days, the IABP was removed and on day 20, the patient’s LVEF increased to 50 %. IABP was successfully used and may improve future prognoses for severely poisoned AlP patients with refractory cardiogenic shock. We encourage clinical toxicologists to examine this new treatment.

Highlights

Atherosclerosis and Coronary Artery Research Center1, Medical Toxicology and Drug Abuse Research Center (MTDRC)2, Department of Cardiac Surgery4,Birjand University of Medical Sciences, Birjand, Addiction Research Centre3, Department of Cardiac Surgery5, Department of Anesthesiology8, Mashhad
We report on the use of an intra-aortic balloon pump (IABP) in a 24-year-old woman brought to our hospital after an intentional ingestion of a tablet of Aluminium phosphide (AlP) (3 g), which caused refractory AlP-induced cardiogenic shock and acute respiratory distress syndrome (ARDS)
AlP poisoning leads to multiorgan failure [9, 10], but death following this poisoning is most often caused by refractory hypotension and cardiogenic shock in the form of toxic chemical myocarditis, which leads to severe left ventricular dysfunction [8, 11, 12]

Summary

Introduction

We report on the use of an intra-aortic balloon pump (IABP) in a 24-year-old woman brought to our hospital after an intentional ingestion of a tablet of AlP (3 g), which caused refractory AlP-induced cardiogenic shock and acute respiratory distress syndrome (ARDS). IABP was successfully used and may improve future prognoses for severely poisoned AlP patients with refractory cardiogenic shock. AlP poisoning leads to multiorgan failure [9, 10], but death following this poisoning is most often caused by refractory hypotension and cardiogenic shock in the form of toxic chemical myocarditis, which leads to severe left ventricular dysfunction [8, 11, 12].

Results

Conclusion