title: Fire extinguisher: an imminent threat or an eminent danger?
abstract: Acute phosphate toxicity following rectal administration of phosphate-containing preparations was documented earlier. However, acute phosphate toxicity due to inhalation of monoammonium phosphate (MAP) is rarely reported. The present report describes the systemic toxicity following intentional inhalation of MAP, a dry chemical powder present in fire extinguishers, in a 25-year-old healthy man with normal renal function resulting in hyperphosphatemia (11.0 mg/dL), hypocalcemia (ionized calcium, 1.18 mg/dL; total calcium, 3.6 mg/dL), hypomagnesemia (1.2 mg/dL), seizures, and 4 episodes of pulseless polymorphic ventricular tachycardia requiring defibrillation. In view of the easy accessibility of fire extinguishers and its likely use for suicidal or homicidal purposes, physicians and practitioners working in emergency departments should be aware of this entity. Early recognition, removal of phosphate by hemodialysis, and supportive care have prevented this case from acute phosphate nephropathy and further complications.
authors.affiliation: Sri Gokulam Hospitals & Research Institute, Salem Tamil Nadu, India. maniansenthil@yahoo.co.in
authors.forename: Subramanian
authors.initials: S
authors.lastname: Senthilkumaran
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Meenakshisundaram
authors.forename: Namasivayam
authors.initials: N
authors.lastname: Balamurgan
authors.forename: Krishnanswamy
authors.initials: K
authors.lastname: SathyaPrabhu
authors.forename: V
authors.initials: V
authors.lastname: Karthikeyan
authors.forename: Ponniah
authors.initials: P
authors.lastname: Thirumalaikolundusubramanian
mesh_terms: D000328:Adult; D005388:Fire Extinguishing Systems; D006801:Humans; D054559:Hyperphosphatemia / Q000139:chemically induced* / Q000175:diagnosis; D006996:Hypocalcemia / Q000139:chemically induced / Q000175:diagnosis; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D010710:Phosphates / Q000506:poisoning*; D012640:Seizures / Q000139:chemically induced; D013406:Suicide, Attempted; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D010710:Phosphates; C024788:ammonium phosphate