• Shahin Shadnia, Kambiz Soltaninejad, Hossein Hassanian-Moghadam, Anahaita Sadeghi, Hormat Rahimzadeh, Nasim Zamani, Alireza Ghasemi-Toussi, and Mohammad Abdollahi.
• Loghman Hakim Hospital Poison Center, Clinical Toxicology Department, Faculty of Medicine and Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
• Hum Exp Toxicol. 2011 Mar 1;30(3):250-3.

IntroductionAcute aluminum phosphide (AlP) poisoning is one of the most common causes of acute pesticide poisoning in Iran. Hydrogen phosphide or phosphine gas is produced following reaction of AlP with water even at ambient humidity. Methemoglobinemia is a rare finding following phosphine poisoning. In this paper, two cases of fatal AlP poisoning complicated by methemoglobinemia are reported.Case ReportTwo patients presented following suicidal ingestion of AlP tablets. In the Emergency Department (ED), they received gastric lavage with sodium bicarbonate and potassium permanganate. Both of them received supportive care. In each case, hematuria and hemolysis were significant events. The patients also showed a decrease in O(2) saturation in spite of high FIO(2). Methemoglobin levels of 40% and 30% were detected by co-oximetry. Neither patient responded to treatment (ascorbic acid in one case, methylene blue in the other). Both patients died due to systemic effects of phosphine poisoning.Discussion And ConclusionHemolysis and methemoglobinemia may complicate the course of phosphine poisoning that seems resistant to methylene blue and ascorbic acid. Therefore, other treatments including hyperbaric oxygen therapy and exchange blood transfusion should be considered.

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