Al / Zinc Phosphide Toxicity Protocol
ER
⬇
Unstable
⬇
ABCD
Stable
⬇
History & Examination
AL / Symptomatic zinc
⬇
Admit in ICU
⬇
ABG, CBC, LFT, KFT, Coagulation, electrolytes, cardiac enzymes, ECG, CXR, Echo
⬇
AL phosphide < 2 hrs delay
Asymptomatic zinc
⬇
Admit inpatient / follow up with serial VBG, LFT, ECG
⬇
Acidosis or any other symptom
GIT decontamination with paraffin oil
⬇
Consider NAC at 21 hrs protocol then at 100 mg/kg TDS (12.5 mg/kg/hr)
IV Lipid emulsion 20% → 1.5 mL/kg bolus over 2–3 min, then infusion 0.25 mL/kg/min (max 10 mL/kg)
If symptomatic patient
⬇
If hypotension develops (SBP < 90 mmHg)
⬇
Insert CVC (If CVP < 12 → Fluid challenge 5–10 mL/kg)
Start norepinephrine → If no response:
Hydrocortisone 200–400 mg q4–6h
⬇
If Cardiac arrhythmias → Antiarrhythmic / DC shock
⬇
If metabolic acidosis → NaHCO₃ (0.6 × Wt × (15 – plasma HCO₃))
If no response → HD
⬇
Acute lung injury / ARDS → Mechanical ventilation
⬇
If pulmonary edema → Diuretics
⬇
No hypotension with low/normal Mg → Magnesium sulphate 1g, then 1g/3h, then 1g/6h
