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

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.

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.

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.

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