Aluminum phosphide fatalities at mild exertion in asymptomatic children: a clue to understand the variations of the autopsy findings.

Fatalities resulted from aluminium phosphide (ALP) intoxication in completely healthy children with no preceded clinical sings or symptoms were presented. Data regarding circumstances, autopsy reports, histopathological examination, toxicological investigation, and police enquiries were also collected and evaluated. The affected children were females, and 6-16 years old. They were completely healthy and died suddenly in relation to some physical activities such as running, walking, and bathing, without any prior complain. The viscera showed intense congestion with moderate to severe pulmonary edema. The cause of the sudden termination of life in the reported cases is mostly cardiac ones. Physical exertion may precipitate death due to increased cardiac stress, increased oxygen demand, and by aggravating metabolic acidosis. The absence of clinical symptoms before death may be due to the low level ALP, or due to the occurrence of death in the early stages after exposure to poison. Death due to ALP could result in cases of mild, moderate, or severe ALP intoxication. This may explain partly the differences encountered in clinical, autopsy, and histopathology findings of ALP intoxication. Fatalities are not the mere consequences of the dose of the poison, but factors such as physical activity and low oxygen level may be quite important.