Successful Treatment of Aluminium Phosphide Poisoning by Extracorporeal Membrane Oxygenation.
Aluminium phosphide (ALP) is one of the most commonly used pesticides worldwide with high mortality rates. Cellular damage and cardiorespiratory failure are the most common causes of mortality and morbidity after poisoning. It is supposed that giving enough time to the patient to survive, the most critical hours after exposure may help the cardiovascular system to recover itself and save the patient's life. During a training workshop for medical extracorporeal membrane oxygenation (ECMO), a 28-year-old ALP-poisoned male was referred to us. Fifty minutes after admission, he developed hypotension and bradycardia and was transferred to ICU. On the second venous blood gas, he had severe metabolic acidosis. After starting the patient on the routine treatment of ALP poisoning, he was a candidate for veno-arterial (VA) ECMO. After three days, lactate level decreased and his general condition improved. On day four, the patient was completely separated from the ECMO machine with acceptable echocardiography and ejection fraction of 40%. One day later, he was extubated, sent to the ward and subsequently discharged in good condition. We suggest this method of treatment for severe ALP poisoning as well as any other poisoning that causes cell toxicity and abrupt cardiovascular or respiratory failure.
Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hossein
H
Hassanian-Moghaddam
Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nasim
N
Zamani
Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mitra
M
Rahimi
Department of Intensive Care Medicine, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mohammadreza
M
Hajesmaeili
Department of Cardiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Maryam
M
Taherkhani
Department of Cardiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Roxana
R
Sadeghi
D000328:Adult; D017607:Aluminum Compounds / Q000506:poisoning*; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D006333:Heart Failure / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D010575:Pesticides / Q000506:poisoning*; D010720:Phosphines / Q000506:poisoning*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000628:therapy; D016896:Treatment Outcome
D017607:Aluminum Compounds; D010575:Pesticides; D010720:Phosphines; D019344:Lactic Acid; C001864:aluminum phosphide