Monitoring Parameters for Zinc Phosphide Poisoning

1.     VITAL SIGNS

Hypotension, shock, and tachycardia occur commonly. 

2.     CARDIOVASCULAR

Cardiac dysrhythmias and ECG abnormalities have ben reported following zinc phosphide ingestions. Hypotension, shock, toxic myocarditis, myocardial failure, and massive focal myocardial injury with elevated cardiac enzymes may occur. 

3.     RESPIRATORY

Cough, dyspnea, cyanosis, chest tightness, and tachypnea may occur. Pulmonary edema has been reported following zinc phosphide ingestion. Zinc phosphide releases toxic and irritating fumes of oxides of phosphorus and zinc oxide when heated to decomposition. Inhalation exposure to such fumes would be predicted to result in respiratory tract irritation with bronchospasm, chemical pneumonitis, or noncardiogenic pulmonary edema. 

4.     NEUROLOGIC

Acute exposure may result in headache, dizziness, fatigue, and CNS depression leading to coma, and chronic exposure may lead to neuropsychiatric manifestations. Seizures are not uncommon after acute exposure. Restlessness and anxiety may be noted following acute zinc phosphide ingestion. 

5.     GASTROINTESTINAL

Nausea, vomiting, and abdominal pain may occur. Pancreatitis has been rarely reported.

6.     HEPATIC

Acute exposure may produce jaundice with hepatomegaly. Elevations of serum transaminases may be noted. 

7.     ACID-BASE

Metabolic acidosis may be seen in acute poisonings. 

8.     FLUID-ELECTROLYTE

 Hypokalemia may occur secondary to profuse vomiting following zinc phosphide ingestion.

9.     ENDOCRINE

Severe hypoglycemia has been reported. 

10.  REPRODUCTIVE

At the time of this review, no data were available to assess the teratogenic potential of this agent. 

Monitoring parameters:

1.     Monitor vital signs & mental status.

2.     Monitor continuous pulse oximetry.

3.     Institute continuous cardiac monitoring & obtain an EEG.

4.     Monitor serum electrolytes, blood glucose, renal function, and liver enzymes.

5.     Obtain a chest radiograph in patients with respiratory symptoms.

References:

1. UpToDate. Available from: http://www.uptodate.com.ezp.imu.edu.my/contents/overview-of-rodenticide-poisoning?source=machineLearning&search=zinc+phosphide&selectedTitle=1%7E1&sectionRank=1&anchor=H352512775#H352516540
2. CDC. Available from: http://www.atsdr.cdc.gov/mmg/mmg.asp?id=1013&tid=214
3. http://www.ncbi.nlm.nih.gov/pubmed/19280425