Methemoglobinemia in aluminum phosphide poisoning.
BACKGROUND
Acute aluminum phosphide (AlP) poisoning is one of the most common causes of acute pesticide poisoning in Iran. Hydrogen phosphide or phosphine gas is produced following reaction of AlP with water even at ambient humidity. Methemoglobinemia is a rare finding following phosphine poisoning. In this paper, two cases of fatal AlP poisoning complicated by methemoglobinemia are reported.


METHODS
Two patients presented following suicidal ingestion of AlP tablets. In the Emergency Department (ED), they received gastric lavage with sodium bicarbonate and potassium permanganate. Both of them received supportive care. In each case, hematuria and hemolysis were significant events. The patients also showed a decrease in O(2) saturation in spite of high FIO(2). Methemoglobin levels of 40% and 30% were detected by co-oximetry. Neither patient responded to treatment (ascorbic acid in one case, methylene blue in the other). Both patients died due to systemic effects of phosphine poisoning.


CONCLUSIONS
Hemolysis and methemoglobinemia may complicate the course of phosphine poisoning that seems resistant to methylene blue and ascorbic acid. Therefore, other treatments including hyperbaric oxygen therapy and exchange blood transfusion should be considered.
Shadnia
Shahin
S
Loghman Hakim Hospital Poison Center, Clinical Toxicology Department, Faculty of Medicine and Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Soltaninejad
Kambiz
K
Hassanian-Moghadam
Hossein
H
Sadeghi
Anahaita
A
Rahimzadeh
Hormat
H
Zamani
Nasim
N
Ghasemi-Toussi
Alireza
A
Abdollahi
Mohammad
M
D000328:Adult; D017607:Aluminum Compounds / Q000506:poisoning*; D000931:Antidotes / Q000627:therapeutic use; D001205:Ascorbic Acid; D002125:Calcium Gluconate / Q000627:therapeutic use; D017809:Fatal Outcome; D005440:Fluid Therapy; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced*; D008751:Methylene Blue / Q000627:therapeutic use; D008875:Middle Aged; D010575:Pesticides / Q000506:poisoning*; D010720:Phosphines / Q000506:poisoning*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013406:Suicide, Attempted
D017607:Aluminum Compounds; D000931:Antidotes; D010575:Pesticides; D010720:Phosphines; D008278:Magnesium Sulfate; D017693:Sodium Bicarbonate; C001864:aluminum phosphide; D001205:Ascorbic Acid; D002125:Calcium Gluconate; D008751:Methylene Blue