Refractory cardiogenic shock caused by zinc phosphide toxicity

Nitish Mittal; Mohamed Elmassry; Mostafa Abohelwa

doi:10.1080/08998280.2022.2136920

Refractory cardiogenic shock caused by zinc phosphide toxicity

Proc (Bayl Univ Med Cent). 2022 Nov 3;36(2):224-225. doi: 10.1080/08998280.2022.2136920. eCollection 2023.

Authors

Nitish Mittal¹, Mohamed Elmassry², Mostafa Abohelwa³

Affiliations

¹ Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas.
² Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
³ Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.

Abstract

Zinc phosphide toxicity is a rare entity that presents most frequently among farmers in developing countries who use it as a rodenticide. The phosphine gas released after the ingestion inhibits cytochrome c oxidase, disrupting the mitochondrial physiology and oxidative phosphorylation and causing myocardial stunning. Here we present a case of a 20-year-old man who attempted suicide with zinc phosphide toxicity. Initially, he was hemodynamically stable with a normal ejection fraction; however, in a few hours, he deteriorated quickly and became hemodynamically unstable, with rapid deterioration of his ejection fraction to 20%. He was started on norepinephrine and then dobutamine; however, he had cardiac arrest from refractory cardiogenic shock despite resuscitative measures.

Keywords: Cardiogenic shock; metal phosphides; zinc phosphide.

Publication types

Case Reports