Cookie monster of a pediatric ingestion of zinc phosphide - 14/07/22

Doi : 10.1016/j.ajem.2022.04.043

Robert Allen, MD ^a,^b,^{^⁎} , Emma R. Furlano, MD ^c, Mark Su, MD, MPH ^d,^e, Sage W. Wiener, MD ^a,^b
^a Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
^b Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, NY, USA
^c Division of Medical Toxicology and Addiction Medicine, Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
^d New York City Poison Control Center, New York, NY, USA
^e Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA

^⁎Corresponding author at: Department of Emergency Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.Department of Emergency MedicineSUNY Downstate Health Sciences University450 Clarkson AvenueBrooklynNY11203USA

Abstract

Background

Zinc phosphide is a highly toxic rodenticide that reacts with hydrochloric acid in the stomach to form phosphine gas. Ingestion of zinc phosphide can result in consequential toxicity even when ingested in small quantities. Clear guidelines are lacking on appropriate personal protective equipment for providers to avoid additional exposure.

Case presentation

We present the case of a four-year-old boy who suffered mild gastrointestinal symptoms after an unintentional ingestion of zinc phosphide. After discussion with the regional Poison Control Center, providers wore powered air-purifying respirators in a negative pressure room and experienced no symptoms of phosphine exposure. The patient was discharged the next day after a complete recovery.

Conclusions

Clinicians should be aware of the potential clinical ramifications to patients who ingest zinc phosphide and the potential risks of caring for such patients. To prevent additional exposure, providers should don appropriate personal protective equipment and contact HAZMAT (or local health department) to safely remove additional zinc phosphide.

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Highlights

•	Zinc phosphide reacts with hydrochloric acid in the stomach to form phosphine gas.
•	Zinc phosphide is highly toxic, even in small quantities.
•	Providers should contact poison control center and don appropriate PPE.

Le texte complet de cet article est disponible en PDF.

Keywords : Toxicology, HAZMAT, Disaster medicine