PMID- 33024386
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220417
IS  - 0972-5229 (Print)
IS  - 1998-359X (Electronic)
IS  - 0972-5229 (Linking)
VI  - 24
IP  - 8
DP  - 2020 Aug
TI  - STEMI in Young Befogged by Aluminum Phosphide Toxicity-Role of ECMO as Salvage 
      Therapy and Trimetazidine and Magnesium to Suppress Arrhythmias.
PG  - 727-730
LID - 10.5005/jp-journals-10071-23533 [doi]
AB  - INTRODUCTION: Aluminum phosphide poisoning (ALP) has a high-mortality rate 
      despite intensive care management, primarily because it causes severe myocardial 
      depression. This case report highlights the subset of ALP patients presenting as 
      ST elevation myocardial infarction (STEMI) with profound myocardial dysfunction 
      and multiorgan failure and successfully treated with extracorporeal membrane 
      oxygenation (ECMO), trimetazidine, and magnesium. CASE DESCRIPTION: A 25-year-old 
      man without any comorbidities was brought to emergency department with dyspnea 
      and hypotension. His electrocardiograph (ECG) revealed STEMI with elevated 
      troponin levels, arterial blood gas (ABG) showed severe metabolic acidosis, and 
      echocardiography (echo) revealed ejection fraction 15%. He was initiated on 
      venoarterial (VA) ECMO in view of refractory hypotension. History of consumption 
      of three tabs of celphos was revealed later by the family members. He progressed 
      to cardiogenic shock, arrhythmias, respiratory failure, acute kidney injury with 
      severe lactic acidosis, liver injury, pancreatitis, and disseminated 
      intravascular coagulation (DIC). He was successfully supported by ECMO, 
      hemodialysis, magnesium, trimetazidine, N-acetyl cysteine, inotropes, and blood 
      products. He was weaned off ECMO on day 6 and was discharged home on day 12. 
      Despite his severe and confounding clinical presentation, he had complete 
      normalization of end-organ dysfunction with no neurological sequela. This case 
      demonstrates the high index of suspicion required for ALP, given the potential 
      for rapid progression and severe multiorgan toxicity. This report also highlights 
      the importance of early referral to a tertiary care center with ECMO capability 
      and also the role of magnesium and trimetazidine to suppress arrhythmias. 
      CONCLUSION: Aluminum phosphide poisoning can present as STEMI with cardiogenic 
      shock resulting in acute kidney injury, liver injury, pancreatitis, and DIC. 
      Venoarterial ECMO provides an effective means of support until the recovery of 
      organ function. Trimetazidine and magnesium are helpful in suppressing fatal 
      arrhythmias. This report emphasizes that early recognition and early institution 
      of ECMO can save many young lives who succumb to toxic effects of this poison. 
      HOW TO CITE THIS ARTICLE: Rao CC, Himaaldev GJ. STEMI in Young Befogged by 
      Aluminum Phosphide Toxicity-Role of ECMO as Salvage Therapy and Trimetazidine and 
      Magnesium to Suppress Arrhythmias. Indian J Crit Care Med 2020;24(8):727-730.
CI  - Copyright (c) 2020; Jaypee Brothers Medical Publishers (P) Ltd.
FAU - Rao, Chaitra C
AU  - Rao CC
AD  - Department of Intensive Care, Apollo Hospitals, Bengaluru, Karnataka, India.
FAU - Himaaldev, Gunavanthi Jayakumar
AU  - Himaaldev GJ
AD  - Department of Critical Care, Apollo Hospitals, Bengaluru, Karnataka, India.
LA  - eng
PT  - Case Reports
PL  - India
TA  - Indian J Crit Care Med
JT  - Indian journal of critical care medicine : peer-reviewed, official publication of 
      Indian Society of Critical Care Medicine
JID - 101208863
PMC - PMC7519610
OTO - NOTNLM
OT  - Aluminum phosphide
OT  - Extracorporeal membrane oxygenation
OT  - Magnesium
OT  - ST elevation myocardial infarction
OT  - Trimetazidine
COIS- Source of support: Apollo Hospitals, Seshadripuram Conflict of interest: None
EDAT- 2020/10/08 06:00
MHDA- 2020/10/08 06:01
PMCR- 2020/08/01
CRDT- 2020/10/07 05:49
PHST- 2020/10/07 05:49 [entrez]
PHST- 2020/10/08 06:00 [pubmed]
PHST- 2020/10/08 06:01 [medline]
PHST- 2020/08/01 00:00 [pmc-release]
AID - 10.5005/jp-journals-10071-23533 [doi]
PST - ppublish
SO  - Indian J Crit Care Med. 2020 Aug;24(8):727-730. doi: 
      10.5005/jp-journals-10071-23533.