Fatal myocardial damage due to zinc phosphide intentional ingestion

We present a case of fatal myocardial damage caused by zinc phosphide ingestion. It is a highly toxic poison that causes life-threatening complications (cardiac and respiratory acute failure above all) by its active metabolite phosphine. Phosphine toxicity's case reports from Europe (and Italy), United States and western countries are rare. A 69-year-old man drunk a great amount of alcohol and unspecified amount of diluted zinc phosphide and was admitted to emergency department with a mild metabolic acidosis and acute respiratory failure. After gastro-intestinal decontamination, a transient improvement of his clinical conditions was observed. In the emergency medicine unit a sudden onset of severe bradycardia and hypotension appeared, electrocardiogram showed an increase in QRS duration with ST elevation in many leads: 2 min later a third-degree atrio-ventricular block was evident. Bradycardia went into asystole and the patient had cardiac arrest. Despite all resuscitative maneuvers, 6 h after zinc phosphide ingestion the patient died. No antidote or specific therapy or management of this potentially life threatening poison are actually available, but only supportive and resuscitative measures.