An interesting case of aluminum phosphide poisoning

Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical
manifestation is extremely wide. A 22-year-old girl was admitted with complaints of
nausea, vomiting and epigastric pain after eating lunch. She had a history of celiac
disease. On arrival, she was alert and hemodynamically stable. There was not any
abdominal tenderness or guarding. Food poisoning treatment initiated but after 1 hour
her condition deteriorated with hypotension, tachycardia, and epigastric pain. Venous
blood gas (VBG) showed severe metabolic acidosis. She denied any drug ingestion
again. New Electrocardiogram (ECG) showed extensive inferolateral ST elevation
myocardial infarction (STEMI). Bicarbonate plus dopamine was initiated. After 8
hours of admission, rhythm became ventricular fibrillation (VF) and cardiopulmonary
resuscitation (CPR) began. Peritoneal dialysis was performed. Next morning frequent
VF occurred again but CPR was unsuccessful. Family found aluminum phosphide (AIP)
tablets in her purse. Early diagnosis and supportive treatment may be effective but the
most important factor is the dose of ingestion