A Complex Rare Presentation of Rice Tablet Poisoning

Abstract

Aluminum phosphide known as the rice tablet (RT) is a common cause of suicide in adult women in Iran, with a high rate of lethal outcome. We report a patient with RT toxicity with a complex syndrome of hepatic failure, renal failure, Brugada electrocardiography (ECG) patterns, and pleuropericardial effusion. The patient received conventional management with fluid therapy, gastric washing, activated charcoal followed by intra-aortic balloon pump insertion, inotropic drugs support, and mechanical ventilation. The unique features of our case related to a combination of multi-organ failure with Brugada atypical ECG patterns and pleuropericardial effusion. Among the aforementioned complication, pleuropericardial effusion, ascitis and Brugada syndrome are exceedingly rare events. The patient treated with high dose inotropic drugs, intra-aortic balloon pump insertion, and despite tremendous management of metabolic acidosis, all efforts were failed and the patient died with sudden cardiac arrest.