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Refractory cardiogenic shock caused by zinc phosphide toxicity
Nitish Mittal1, Mohamed Elmassry2, Mostafa Abohelwa3
1Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas.
Proceedings (Baylor University. Medical Center)
|March 6, 2023
Summary
Zinc phosphide poisoning, a rare rodenticide toxicity, can cause severe myocardial stunning. This case highlights rapid cardiac deterioration and refractory cardiogenic shock despite medical intervention.
Area of Science:
- Toxicology
- Cardiology
- Mitochondrial Physiology
Background:
- Zinc phosphide is a rodenticide commonly used in developing countries.
- Ingestion releases phosphine gas, inhibiting cellular respiration.
- This disruption leads to myocardial stunning and cardiac dysfunction.
Observation:
- A 20-year-old male presented with zinc phosphide toxicity after a suicide attempt.
- Initially hemodynamically stable with preserved ejection fraction.
- Rapid deterioration occurred within hours, leading to hemodynamic instability.
Findings:
- Ejection fraction dropped to 20% despite initial stability.
- Treatment with norepinephrine and dobutamine was initiated.
- The patient experienced cardiac arrest due to refractory cardiogenic shock.
Implications:
- Zinc phosphide toxicity can lead to acute, severe cardiac dysfunction.
- Prompt recognition and aggressive management are crucial.
- Further research into specific antidotes or treatments for phosphine-induced cardiotoxicity is warranted.
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