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

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.