title: Methemoglobinemia in aluminum phosphide poisoning.
abstract: 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.
authors.affiliation: Loghman Hakim Hospital Poison Center, Clinical Toxicology Department, Faculty of Medicine and Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shahin
authors.initials: S
authors.lastname: Shadnia
authors.forename: Kambiz
authors.initials: K
authors.lastname: Soltaninejad
authors.forename: Hossein
authors.initials: H
authors.lastname: Hassanian-Moghadam
authors.forename: Anahaita
authors.initials: A
authors.lastname: Sadeghi
authors.forename: Hormat
authors.initials: H
authors.lastname: Rahimzadeh
authors.forename: Nasim
authors.initials: N
authors.lastname: Zamani
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghasemi-Toussi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdollahi
mesh_terms: 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
chemical_list: 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