Successful survival after severe aluminum phosphide poisoning complicated by cardiogenic shock, atrial fibrillation and severe metabolic acidosis: a case report

Aluminum phosphide (ALP) is a highly toxic pesticide, which is widely used in agriculture. Ingestion leads to multiorgan dysfunction through phosphine-induced cellular toxicity. Most commonly reported causes of death are cardiovascular collapse, metabolic acidosis, and arrhythmias. There exists no distinct antidote, and attentive supportive care is the key here. We report a 28-year-old Bangladeshi male who has a history of a major depressive disorder and attempted suicide by taking a single tablet of ALP (approximately 3 g). The patient came in with hypotension, irregular pulse, vomiting, and severe metabolic acidosis. ECG showed atrial fibrillation. The patient was put on aggressive intravenous fluids, titrated noradrenaline infusion, oral N-acetylcysteine administered through nasogastric tube, intravenous hydrocortisone, sodium bicarbonate and the usual supportive care in the ICU. Although he became unstable at first, his condition improved over time; the arrhythmia resolved and the acidosis corrected; he was discharged on the sixth day with psychiatric follow-up. With prompt and effective supportive care, survival in severe cases of ALP poisoning can be achieved. Rapid hemodynamic stabilization, correction of metabolic derangements, and antioxidant therapy can help to improve the outcome. The case highlights the need to recognize it as soon as possible, closely monitor it, and implement preventive strategies to decrease ALP-associated fatalities.