Zinc phosphide is a gray to black powder mainly used as a rodenticide. In contact with gastric fluid, it releases phosphine which is the main toxic material of this compound. Phosphine interferes with oxidative respiratory cycle of the cells, but is generally expected to manifest its toxicity with prodromal signs and symptoms including abdominal pain, nausea and vomiting, metabolic acidosis, and increased liver function tests. A 64-year-old man was referred to our center with the history of ingestion of three full table spoons of zinc phosphide powder with only a mild GI discomfort. Abdominal X-ray revealed radiopaque material in epigastric and abdominal right upper quadrant. Despite treatment with polyethylene glycol and completely normal vital signs and lab tests, he experienced sudden cardiac arrest 19 h after admission. Autopsy showed clues of focal myopathy and fibrosis with evidences of ischemia and congestion in cardiac tissue, pulmonary edema, shrunken bilateral kidneys, and nutmeg yellow liver. Toxicology panel confirmed the presence of phosphine and zinc phosphide in the gastric fluid. The patient deteriorated suddenly despite being completely symptom-free during the hours preceding cardiovascular arrest. Since the cardiopulmonary injury is the most rampant cause of early death, checking of the cardiac enzymes and cardiac monitoring could be beneficial for early detection and efficient management of these patients.

中文翻译：

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无症状磷化锌中毒患者心脏骤停：一例报告。

磷化锌是一种灰色至黑色的粉末，主要用作灭鼠剂。与胃液接触会释放磷化氢，磷化氢是该化合物的主要毒性物质。磷化氢会干扰细胞的氧化呼吸循环，但通常预计其毒性会表现为前驱体征和症状，包括腹痛、恶心和呕吐、代谢性酸中毒和肝功能检查增加。一名 64 岁的男性被转介到我们的中心，他有摄入三整汤匙磷化锌粉末的病史，但仅有轻微的胃肠道不适。腹部 X 光显示上腹和腹部右上腹有不透射线物质。尽管接受了聚乙二醇治疗并且生命体征和实验室检查完全正常，但他在入院后 19 小时出现心脏骤停。尸检显示局灶性肌病和纤维化的线索，并有心肌组织缺血和充血、肺水肿、双侧肾脏萎缩和肉豆蔻黄肝的证据。毒理学小组确认胃液中存在磷化氢和磷化锌。尽管在心血管骤停前数小时内完全没有症状，但患者病情突然恶化。由于心肺损伤是导致早期死亡的最常见原因，检查心肌酶和心脏监测可能有利于这些患者的早期发现和有效管理。毒理学小组确认胃液中存在磷化氢和磷化锌。尽管在心血管骤停前数小时内完全没有症状，但患者病情突然恶化。由于心肺损伤是导致早期死亡的最常见原因，检查心肌酶和心脏监测可能有利于这些患者的早期发现和有效管理。毒理学小组确认胃液中存在磷化氢和磷化锌。尽管在心血管骤停前数小时内完全没有症状，但患者病情突然恶化。由于心肺损伤是导致早期死亡的最常见原因，检查心肌酶和心脏监测可能有利于这些患者的早期发现和有效管理。