Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emergency Medicine Journal : EMJ. 2006;23(1):e3. doi:10.1136/emj.2004.015941.

“A previously well 41 year old Indian woman presented 2 hours after ingestion of a 10 g sachet of Fumino (aluminium phosphide (AlP) 56% w/w; United Phosphorus) mixed with water. She was distressed, vomiting, and had severe epigastric pain with blood pressure 70/58 mmHg, pulse 100 beats/min, oxygen saturation 86% on air, and temperature 37.1°C. Arterial blood gases (ABG) on 10 l/min oxygen showed pO₂ 37.7 kPa, pCO₂ 3.04 kPa, pH 7.27, bicarbonate 13.2 mmol/l, and base excess (BE) −14.4. Chest x ray showed bilateral pulmonary infiltrates and ECG a sinus tachycardia (fig 1A​1A).). She was treated with intravenous colloid (1 litre Gelofusion over 30 minutes), 200 mg hydrocortisone, 40 mg pantoprazole, 300 mg phenytoin, and 50 mmol sodium bicarbonate. Infusions of N‐acetylcysteine (6.5 g over 24 h) and magnesium sulphate (70 mmol/l over 24 hours) were commenced. She remained hypotensive and her clinical condition deteriorated with worsening hypoxia and metabolic acidosis (ABG on 15 l/min O₂: pO₂ 10.6 kPa, pCO₂ 4.24 kPa, pH 7.16, bicarbonate 12 mmol/l, BE –16). She was paralysed, intubated, and ventilated. Metabolic acidosis was treated with 50 mmol/h sodium bicarbonate but despite fluid resuscitation, she required norepinephrine and later epinephrine infusion (maximum 3 µg/kg/min) to maintain blood pressure. Continuous venous–venous haemofiltration was commenced in an attempt to correct the acidosis. A portable echocardiograph (Sonoheart Elite) showed normal left ventricle (LV) size with moderately impaired LV function and cardiac index of 1.5 l/min/m². A broad complex tachycardia (fig 1B​1B)) occurred, which was treated with amiodarone (300 mg over 1 hour). Serial creatinine kinase, and amylase were within normal limits. Subsequently she developed disseminated intravascular coagulation and adult respiratory distress syndrome. Despite supportive management she died 36 hour after admission.”