The first reported mortality from aluminum phosphide poisoning in Lebanon: a case report.

BACKGROUND: Aluminum phosphide is a commonly used pesticide, particularly in developing countries where uncontrolled insecticides and pesticides are commonly prevalent. Mortalities have been reported due to accidental and suicidal exposures to aluminum phosphide. To date, there has been no reported mortality case of aluminum phosphide in Lebanon. In addition, there is no specific antidote for aluminum phosphide toxicity and the treatment is mainly supportive. This is why awareness should be spread about this case to include it in the differential diagnoses and enhance prompt management and response in future encounters. CASE PRESENTATION: A previously healthy 37-year-old male, presented to the emergency department of Notre Dame des Secours University Hospital Center for a suicidal attempt after ingesting 5 tablets of pesticide containing 56% aluminum phosphide an hour prior to presentation. Shortly after the presentation, the patient began deteriorating and became clinically unstable. The patient was then intubated and was started on sodium bicarbonate along with aggressive fluid resuscitation. The patient remained hypotensive even after giving vasopressors. He was then later admitted to the intensive care unit for further management. However, the patient further decompensated and developed multiorgan failure. This is the first case of mortality in Lebanon from aluminum phosphide toxicity. CONCLUSIONS: Emergency physicians should include aluminum phosphide toxicity in the differential diagnosis when dealing with patients ingesting unknown pesticides especially when they smell the characteristic garlic-like odor. The toxicity from ALP leads to multiorgan failure and death rapidly. Thus, it is of utmost importance to start early, and aggressive resuscitation given that there is no specific antidote.

Hemoptysis after subclavian vein puncture for pacemaker implantation: importance of wire-guided venous puncture.

We report a case of hemoptysis occurring after subclavian vein puncture for pacemaker implantation. Hemoptysis related to injury of lung parenchyma is a rare complication of subclavian vein access and is usually self limited, but can affect prognosis in critically ill patients. Venogram-guided or even better wire-guided venous puncture allow safe access to the subclavian vein in difficult cases. A review of the pertinent literature is also presented.