Case report: Levosimendan as a possible inotropic drug for acute aluminum phosphide toxicity

Meray Medhat Shokry  Zaghary; Salah Eldeen Tag Elsir  Ali; John Medhat Shokry  Zaghary; Bishoy Reyad GabAllah  Issa; Nourseen Effat Abd El_Gaber  Ajamy

doi:10.59400/jts3031

Case report: Levosimendan as a possible inotropic drug for acute aluminum phosphide toxicity

Meray Medhat Shokry Zaghary Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt
Salah Eldeen Tag Elsir Ali Faculty of Pharmacy, Stellenbosch University, Stellenbosch 7602, South Africa
John Medhat Shokry Zaghary Faculty of Medicine, Sohag University, Sohag 82524, Egypt
Bishoy Reyad GabAllah Issa Faculty of Medicine, Sohag University, Sohag 82524, Egypt
Nourseen Effat Abd El_Gaber Ajamy Faculty of Medicine, Sohag University, Sohag 82524, Egypt

Article ID: 3031

DOI: https://doi.org/10.59400/jts3031

Keywords: aluminum phosphide; levosimendan; inotropic; acute toxicity

Abstract

Background: Aluminum phosphide is a severe poisoning that can lead to death. Easy availability with no specific antidote is the leading cause of the higher mortality with it. Case report: The study represents a case report of a 5-year-old male who came after oral ingestion of aluminum phosphide and presented with vomiting, sleep, low blood pressure of 80/20, and a regular and rapid pulse of about 140 per minute. Gastric lavage was done rapidly with 3 bottles of paraffin oil, then 1 bottle was given every 1 h for 4 cycles. Complete laboratory investigations were performed for the patient, such as arterial blood gas, liver enzymes, electrolytes, full blood count, and renal function, which showed normal function except for metabolic acidosis with overcompensated respiratory alkalosis. The patient was transferred to the pediatric intensive care unit, where we gave a dose of 1 mEq sodium bicarbonate per kg with N-acetylcysteine 150 mg/kg in 100 mL of 5% glucose for 2 h under coverage of hydrocortisone and Avil. Antiemetics and proton pump inhibitors were given regularly every 12 h. After discussion with the pediatric specialist, the ejection fraction of the child by echocardiography was low, about 40%, and levosimendan was recommended to be given to the patient. The patient was given a bolus dose of 6 µg/kg over 10 min, followed by an infusion of 0.1 µg/kg/min with excellent response for 48 h. After admission for one week, the patient recovered completely, the ejection fraction became 55%, and the patient was discharged safely to home. Conclusion: Acute accidental exposure to AlP, either accidentally or suicidally or rarely homicidally, presents a significant threat to human life with many toxic effects, especially on the heart. Levosimendan is a drug that is used in decompensated heart failure and can be used as an inotropic agent in acute AlP toxicity.

Published

2025-06-13

How to Cite

Zaghary, M. M. S., Ali, S. E. T. E., Zaghary, J. M. S., Issa, B. R. G., & Ajamy, N. E. A. E. (2025). Case report: Levosimendan as a possible inotropic drug for acute aluminum phosphide toxicity. Journal of Toxicological Studies, 3(1), 3031. https://doi.org/10.59400/jts3031

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Issue

Vol. 3 No. 1 (2025)

Section

Case Report

This work is licensed under a Creative Commons Attribution 4.0 International License.

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Insecticides represent the most used control method against the insect pests of stored food products. But there are strains of insects which are resistant to these insecticides: it is the case of the beetle of the chickpea Callosobruchus maculatus . The present study has for objective the evaluation of the biological activity of chitinolytic enzymes extracted from the fish offals Scorpaena scrofa (scorpion fish) on this beetle at different doses (3%, 6%, 9%, 12%, 15% and 21%) prepared with the buffer solution. The results obtained from three treatments (T 1 , T 2 and T 3 ) realized according to the dose of the crude enzyme and the time of exposure were compared with those of the controls and have showed a very significant efficiency of our crude enzyme on the reduction of the fertility rate of 100% by treating the couple (T 1 ) at the same time as to treat the male (T 3 ) and the female (T 2 ) separately with the strongest dose (21%) for 48 h of exposure. It would be thus desirable to demonstrate the activity of these enzymes in the real conditions of storage.

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