High-dose regular insulin as a potential rescue therapy in severe aluminum phosphide poisoning: a case report

Aluminum phosphide (rice tablet) can cause cardiocirculatory collapse and has negative cardiac inotropic effect. Positive inotropic effect of insulin on the cardiac myocytes is through calcium flux. Insulin increases the intramyocytes calcium concentration by increasing conductance of calcium through the L-type calcium channels and by increasing intramyocytes concentration of cyclic adenosine monophosphate. In addition to increasing the intramyocytes calcium level, insulin also enhances the responsiveness of the cardiac cells to calcium. High-dose insulin is a potential therapy for hypodynamic and hypotensive septic shock due to its positive inotropic qualities.

In this paper, a critical aluminum phosphide poisoning patient (a 25-year-old Iranian young woman), presented with mixed severe metabolic acidosis and respiratory alkalosis, tachypnea, tachycardia, and hypotension. In contrast to our previous experiences that ingestion of aluminum phosphide tablets associated with multiple organ failure and severe shock in approximately all critical poisoning patients, early initiation of high-dose intravenous regular insulin for this patient prevented multiorgan dysfunction and death. Treatment with high-dose intravenous insulin associated with IV fluids, sodium bicarbonate, hydrocortisone, potassium, dextrose therapy and supportive care resolved completely signs and symptoms of patient after 3 days in ICU.

High-dose intravenous regular insulin may be act as a rescue therapy for aluminum phosphide poisoning patients. While this single case suggests a potential benefit, further studies are required to confirm these findings.