Sudden Cardiac Arrest in an Asymptomatic Zinc Phosphide-Poisoned Patient: A Case Report
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Sudden Cardiac Arrest in an Asymptomatic Zinc Phosphide‑Poisoned Patient: A Case Report Parinaz Parhizgar1 · Reza Forouzanfar2 · Seyed Kaveh Hadeiy1 · Nasim Zamani1,3 · Hossein Hassanian‑Moghaddam1,3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Zinc phosphide is a gray to black powder mainly used as a rodenticide. In contact with gastric fluid, it releases phosphine which is the main toxic material of this compound. Phosphine interferes with oxidative respiratory cycle of the cells, but is generally expected to manifest its toxicity with prodromal signs and symptoms including abdominal pain, nausea and vomiting, metabolic acidosis, and increased liver function tests. A 64-year-old man was referred to our center with the history of ingestion of three full table spoons of zinc phosphide powder with only a mild GI discomfort. Abdominal X-ray revealed radiopaque material in epigastric and abdominal right upper quadrant. Despite treatment with polyethylene glycol and completely normal vital signs and lab tests, he experienced sudden cardiac arrest 19 h after admission. Autopsy showed clues of focal myopathy and fibrosis with evidences of ischemia and congestion in cardiac tissue, pulmonary edema, shrunken bilateral kidneys, and nutmeg yellow liver. Toxicology panel confirmed the presence of phosphine and zinc phosphide in the gastric fluid. The patient deteriorated suddenly despite being completely symptom-free during the hours preceding cardiovascular arrest. Since the cardiopulmonary injury is the most rampant cause of early death, checking of the cardiac enzymes and cardiac monitoring could be beneficial for early detection and efficient management of these patients. Keywords Zinc phosphide · Death · Sudden cardiac arrest · Autopsy
Introduction Suicidal death due to pesticides is relatively common in Iran due to their cheap price and easy access [1]. Zinc phosphide is a gray to black powder compound with garlic to rotten fish odor mainly used as a rodenticide which may be detected in radiological work-ups due to the radiopacity of the zinc [2]. Its mechanism of toxicity is releasing phosphine gas when it combines with gastric fluid [3]. The released phosphine Handling editor: Dr. Gen Suzuki. * Hossein Hassanian‑Moghaddam [email protected] 1
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2
Department of Emergency Medicine, Shahed University, Tehran, Iran
3
Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran
interferes with the function of cytochrome oxidase C enzyme and respiratory cycle of the cells [4]. Currently there are no available antidotes for zinc phosphide intoxication, and treatment plan is mainly comprised of conservative measures. Most early deaths happen due to toxic effects of phosphine gas on cardiopulmonary system [5]. Dysrhythmias, congestive heart failure, pulmonary edema, myo
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