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2008, Number 6

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Med Int Mex 2008; 24 (6)

Non-cardiogenic acute pulmonary edema in patients with zinc phosphide poisoning. Two cases report and literature review

López II, Lozano NJJ
Full text How to cite this article

Language: Spanish
References: 14
Page: 424-427
PDF size: 111.24 Kb.


Key words:

pulmonary acute edema, zinc phosphide, poisoning.

ABSTRACT

Zinc 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.


REFERENCES

  1. Fitzpatrick RJ, et al. The toxicity of rodenticides, red squill and zinc phosphide. Vet Rec 1985;67:142-45.

  2. Marcus S. Toxicity rodenticide. Emedicine 2007;11:1-10.

  3. Castel SW, Bailey EM. A review of zinc phosphide poisoning. Vet Hum Toxicol 1986;28:151-54.

  4. Hernández C, Rosiles M. Intoxicación por fosfuro de zinc en una yegua. Vet Mex 2002; 33(3):343-46.

  5. Watson WA, Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, et al. 2003 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2004;22(5):335-404.

  6. Nogué S. Intoxicaciones por rodenticidas. Toxicología clínica.1ª ed. Barcelona: Springer-Verlag Ibérica, 1993;pp:267- 74.

  7. Amr MM, Abbas EZ, El-Samra M, et al. Neuropsychiatric syndromes and occupational exposure to zinc phosphide in Egypt. Environ Res 1997;73(1-2):200-6.

  8. Lagnese M, et al. Evaluation and management of toxicologic emergencies. Critical Care Study Guide Text and Review 2002:286-98.

  9. Bennett DR, Baird CJ, Chan K-M, et al. Zinc toxicity following massive coin ingestion. Am J Forensic Med Pathol 1997;18:148-53.

  10. McKinney PE, Brent J, Kulig K. Acute zinc chloride ingestion in a child: local and systemic effects. Ann Emerg Med 1994;23:1383-87.

  11. Agnew DW, Barbiers RB, Poppenga RH, Watson GL. Zinc toxicosis in a captive striped hyena. J Zoo Wildl Med 1999;30:431- 34.

  12. Meurs KM, Breitschwerdt EB, Baty CJ, Young MA. Postsurgical mortality secondary to zinc toxicity in dogs. Vet Hum Toxicol 1991;33:579-83.

  13. Murphy JV. Intoxication following ingestion of elemental zinc. JAMA 1970;212:2119–20.

  14. Dawn B, Mair E, Cable B, et al. Chronic Ingestion of a Zinc- Based Penny. Pediatrics 2003;111:689-91.




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Med Int Mex. 2008;24