Successful management of zinc phosphide poisoning—a Hungarian case

International Journal of Emergency Medicine

Csilla Somoskövi¹  Júlia Héger²  Gergely Bilics²  Csaba Varga³  Gábor Bajzik⁴  Csaba Nagy⁵  Éva Pozsgai⁶ 

[1] Center of Psychiatry and Addictology, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, 7400, Kaposvár, Hungary;Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, 7400, Kaposvár, Hungary;Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, 7400, Kaposvár, Hungary;Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Vörösmarty Mihály Street 4, 7621, Pécs, Hungary;Department of Radiology, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, 7400, Kaposvár, Hungary;Department of Radiology, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, 7400, Kaposvár, Hungary;Department of Neurosurgery, Clinical Center, University of Pécs, Szigeti Street 12, 7624, Pécs, Hungary;Institute of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, 7623, Pécs, Hungary;Department of Public Health, Medical School, University of Pécs, Szigeti Street 12, 7624, Pécs, Hungary;

关键词: Zinc phosphide;    Alpha-lipoic acid;    Dihydrolipoic acid;    Pneumonia;    Poisoning;    N-acetylcysteine;    Pseudocholinesterase;   

DOI  :  10.1186/s12245-020-00307-8

来源: Springer

【 摘 要 】

BackgroundZinc phosphide (ZnP) is the basic component of several insecticides easily accessible worldwide. Intentional or accidental intoxication may lead to severe complications and multiple organ failure, resulting in high mortality. No known antidote is currently available. The iron-chelation and the antioxidative effects are well-known features of alpha-lipoic acid (ALA), although its use in the treatment of ZnP poisoning has not been documented previously. We describe the case of a patient with serious ZnP poisoning with multiple organ failure, where ALA was also included in the patient’s supportive therapy.Case presentationA 65-year-old man ingested 125 g of Arvalin® (containing 5 g ZnP) and presented to the Emergency Department, with respiratory insufficiency and decreased consciousness. He developed hypokalemia, hypocalcemia, low white blood cell count, elevated C-reactive protein level, mixed acidosis, hepatic and kidney damage, thickening of the jejunal wall, and lung atelectasis, which served as a basis for the ensuing bacterial pneumonia. Antibiotics and adequate supportive therapy were provided. Laboratory tests indicated liver damage (slightly increased liver enzymes, low pseudocholinesterase levels; 706 U/L on day 2), possibly caused by the patient’s chronic alcoholism or the ZnP poison itself, therefore, hepatoprotective agents, ALA (Thiogamma Turbo-Set®) with N-acetylcysteine were administered for six consecutive days. Pseudocholinesterase values increased sixfold until the end of the second week of care. Fifteen days after admission, the patient was relocated to the department of psychiatry with stable vital functions, clear consciousness, declining inflammatory markers, and improved liver function. He was discharged 1 month later, fully recovered.ConclusionsOur case is the first documented voluntary and severe ZnP poisoning in Hungary. Our patient developed multiple organ failure and atelectasis, possibly resulting in the observed respiratory infection. The development of bacterial pneumonia highlighted the dangers of phosphine-induced atelectasis. The use of ALA in our patient’s case, as an antioxidant and agent for metal chelation, suggested that this agent could be a promising tool in the prevention and treatment of ZnP-induced hepatic damage.

【 授权许可】

CC BY