Phosphine poisoning: a case series including one fatality following fumigation with aluminium phosphide.

INTRODUCTION

Aluminium phosphide is a highly toxic fumigant pesticide that releases phosphine upon contact with moisture. Phosphine primarily targets the cardiovascular system and may result in multi-organ failure.

CASE SERIES: Four individuals from the same household were exposed when the apartment directly below their own was fumigated. After the index case was diagnosed with acute gastroenteritis and discharged, he found a housemate unconscious. On admission, she had a Glasgow Coma Scale of 4, her pulse rate was 43 beats/min, her temperature was 34.3 °C, and her blood pressure was 85/60 mmHg. Her pupils were fixed and dilated; she suffered cardiac arrest and died 8 h after admission. Complaints of nausea and vomiting in two others led to the consideration of a potential toxic exposure.

DISCUSSION: Toxic exposure should be considered when multiple individuals from the same environment present with similar symptoms. This case series highlights the diagnostic challenge posed by phosphine inhalation as a result of aluminium phosphide use. Early symptoms may mimic benign conditions such as gastroenteritis. In fatal cases, rapid progression to shock, dysrhythmias, and multi-organ failure may occur.

CONCLUSION

Four individuals from the same household were exposed to phosphine generated from the use of aluminium phosphide; one died after developing severe cardiovascular collapse.