2008, Number 6
Non-cardiogenic acute pulmonary edema in patients with zinc phosphide poisoning. Two cases report and literature review
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ABSTRACTZinc phosphide poisoning (ZPP) is a cause of sudden death due to ingestion of rodenticides with suicidal purpose. It has high mortality rate (37 to 100%), and lethal dose in humans is 80 mg/kg. Severe ZPP lead a sudden organic failure (lung, kidney, liver, heart). We report two patient cases, one male and one female, with 36 and 22 years old, respectively, who ate a bottle of 50 g of rodenticide (zinc phosphide) to commit suicide. Within a few minutes they show diaphoresis, blurred vision, nausea, grey vomiting, abdominal pain, middle effort dyspnea, and facial ruddy; on Intensive Care Unit (ICU) admission they were hemodynamically and biochemically stable, only with metabolic acidosis. Eight hours after, suddenly they showed petechiae, conjunctival haemorrhages, haematuria (with normal platelets and coagulation times), respiratory distress, refractory metabolic acidosis to treatment, clinical, radiographic and haemodynamic EAPNC, hypotension, requiring mechanical ventilatory support, peritoneal dialysis, crystalloid solutions, and vasoactive amines. Male patient died 22 hours after admission, and female patient evolve satisfactorily until her discharge 72 hours after. Acute ZPP causes sudden death due to lack of antidote. It is required an ICU attention due to its cardio-pulmonary effects, even if there is stability hours before.
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