A case report of zinc phosphide poisoning: complicated by acute renal failure and tubulo interstitial nephritis.

Title A case report of zinc phosphide poisoning: complicated by acute renal failure and tubulo interstitial nephritis.
Authors N. Yogendranathan; H.M.M.T.B. Herath; T. Sivasundaram; R. Constantine; A. Kulatunga
Journal BMC Pharmacol Toxicol
DOI 10.1186/s40360-017-0144-7

BACKGROUND: Run Rat® is a rodenticide widely used against small mammals. It comprises of a minimum of 32% zinc phosphide which is highly toxic in acute exposures to humans. It may be consumed accidentally or intentionally. It enters the body via skin, respiratory and gastrointestinal tracts. Zinc phosphide is hydrolyzed by the gastric acid and is transformed into phosphine gas. Phosphine is a respiratory toxin that inhibits cytochrome C oxidase system resulting in renal failure and liver failure.

CASE PRESENTATION: A 35 year old Sri Lankan female presented following ingestion of 2.5 g of Run Rat®, which is a branded preparation of zinc phosphide, resulting in 61 mg/kg poison load. She developed severe acute kidney injury with acute tubular necrosis, subnephrotic ranged proteinuria and tubulointerstitial nephritis for which she underwent haemodialysis three times along with other measures of resuscitation. She also developed elevated liver enzymes with hyperblirubinaemia, hypoalbuminaemia, acute pancreatitis and mild myocarditis. She improved with supportive therapy over a period of 3 weeks.

CONCLUSION: Run Rat® is a commonly used rodenticide and the toxic effects are mediated through conversion of phosphide to phosphine gas. The majority of the deaths had occurred in the first 12 to 24 h and the main causes identified are refractory hypotension and arrhythmias. The late deaths (beyond 24 h) had been commonly due to adult respiratory distress syndrome, liver and renal failure. The outcome is poorer with delayed presentation, development of coagulopathy, hyperglycaemia and multiorgan failure with elevated liver enzymes. In our patient, Zinc phosphide poisoning caused severe acute kidney injury, abnormal liver profile, pancreatitis and possible myocarditis. The patient improved with repeated haemodialysis. The renal biopsy revealed acute tubulointerstitial nephritis with acute tubular necrosis. In tropical countries, the rural population engaged in agriculture has easier access to the compound, as it is available at a lower cost. Furthermore, the lack of an antidote and advanced resuscitative measures such as inotropic supportive therapy and renal replacement facilities at most of the peripheral hospitals pose a major challenge in providing timely interventions to prevent deaths.

Citation N. Yogendranathan; H.M.M.T.B. Herath; T. Sivasundaram; R. Constantine; A. Kulatunga.A case report of zinc phosphide poisoning: complicated by acute renal failure and tubulo interstitial nephritis.. BMC Pharmacol Toxicol. 2017;18(1):37. doi:10.1186/s40360-017-0144-7

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Phosphorus Bohr ModelSee more Phosphorus products. Phosphorus (atomic symbol: P, atomic number: 15) is a Block P, Group 15, Period 3 element. The number of electrons in each of Phosphorus's shells is 2, 8, 5 and its electronic configuration is [Ne] 3s2 3p3. The phosphorus atom has a radius of 110.5.pm and its Van der Waals radius is 180.pm. Phosphorus is a highly-reactive non-metallic element (sometimes considered a metalloid) with two primary allotropes, white phosphorus and red phosphorus its black flaky appearance is similar to graphitic carbon. Compound forms of phosphorus include phosphates and phosphides. Phosphorous was first recognized as an element by Hennig Brand in 1669 its name (phosphorus mirabilis, or "bearer of light") was inspired from the brilliant glow emitted by its distillation.


See more Zinc products. Zinc (atomic symbol: Zn, atomic number: 30) is a Block D, Group 12, Period 4 element with an atomic weight of 65.38. The number of electrons in each of zinc's shells is 2, 8, 18, 2, and its electron configuration is [Ar] 3d10 4s2. Zinc Bohr ModelThe zinc atom has a radius of 134 pm and a Van der Waals radius of 210 pm. Zinc was discovered by Indian metallurgists prior to 1000 BC and first recognized as a unique element by Rasaratna Samuccaya in 800. Zinc was first isolated by Andreas Marggraf in 1746. In its elemental form, zinc has a silver-gray appearance. It is brittle at ordinary temperatures but malleable at 100 °C to 150 °C.Elemental Zinc It is a fair conductor of electricity, and burns in air at high red producing white clouds of the oxide. Zinc is mined from sulfidic ore deposits. It is the 24th most abundant element in the earth's crust and the fourth most common metal in use (after iron, aluminum, and copper). The name zinc originates from the German word "zin," meaning tin.

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