Survival After Severe Aluminum Phosphide Poisoning Complicated by Concurrent Insulin Overdose: A Case Report

Aluminum phosphide (ALP) poisoning remains highly lethal due to rapid cardiotoxicity, refractory hypotension, and metabolic disturbances. We report a rare case of a 31-year-old male presenting with severe hypoglycemia and decreased consciousness following intentional insulin overdose, who was later found to have concurrent ALP ingestion. Prompt correction of hypoglycemia, early gastrointestinal decontamination, and intensive supportive care—including vasopressors, magnesium supplementation, and continuous hemodynamic monitoring—were initiated. Despite transient hypotension and metabolic acidosis, the patient achieved complete recovery without organ dysfunction. This case highlights the diagnostic challenges of overlapping toxicological conditions, in which insulin-induced hypoglycemia may obscure the early manifestations of ALP poisoning. It also emphasizes the importance of repeated clinical reassessment and early, aggressive supportive care. This report adds to the limited literature on mixed toxic exposures and underscores the critical role of maintaining a broad differential diagnosis in atypical presentations, particularly in regions where ALP is prevalent. • Rare survival after severe aluminum phosphide poisoning with insulin overdose. • Early decontamination and ICU supportive care enabled recovery. • Hypotension and metabolic acidosis were successfully managed. • Repeated reassessment is key for atypical presentations