الفهرس 
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Abstract
Metal phosphides are one of the most commonly used pesticides in agricultural countries. The wide use of metal phosphides could be attributed to their high potency along with low prices. Unfortunately, exposure of humans to metal phosphides leads to high morbidity and mortality.
Thus, the present study was carried out to study the pattern of zinc phosphide poisoning among patients admitted to Alexandria Poison Center (APC) and to evaluate clinical, laboratory and radiological findings as prognostic indicators in acute zinc phosphide poisoning patients.
This study was carried out on 150 patients with acute zinc phosphide poisoning who were admitted to APC for six months from the first of August 2018 till the end of January 2019. Informed consent was obtained from all patients or their guardians. All patients were interviewed and clinically assessed then laboratory and radiological investigations were conducted. Proper management and careful follow-up were considered in all cases.
The age of the patients ranged from 1 to 50 years with a mean of 23.36 ±13.53 years. More than two-thirds (68.7%) of the cases were females. The cases were from three governorates (Alexandria, Beheira and Kafr-Elsheikh) who represent 70.7%, 22.7% and 6.7% respectively. Most of the cases (76%) ingested zinc phosphide intentionally.
The amount taken ranged from 0.25 sachet to 6 sachets with a mean of 1.67±1.59 sachets. Nearly two-thirds (68.7%) of the cases took less than two sachets and nearly half (48.6%) of the cases arrived in less than two hours since zinc phosphide poison ingestion.
Regarding the poisoning severity score (PSS) of the cases, 11 cases (7.3%) were grade 2 (pronounced symptoms), 68 cases (45.3%) were grade 1 (mild symptoms) and the rest of the cases 71 (47.3%) were grade 0 (asymptomatic) on admission. After 12 hours, two cases (1.3%) developed severe symptoms (grade 3). In addition, the number of cases in grade 1 (53.3%) and 2 (23.3%) increased at the expense of the decrease in the number of asymptomatic cases (22%).
The 2 cases in grade 3 were still having severe manifestations 24 hours after admission and there was a noticeable improvement in the other patients demonstrated by a decrease in the number of cases in grade 2 (18%) and grade 1 (36%). The improvement proceeded in 36 hr, 48 hr, and 60 hr in the form of the disappearance of the grade 3 cases and the gradual decrease in grade 1 and 2 cases at the expense of increasing in asymptomatic cases. After 72 hours, the majority of patients (97.4%) were clinically asymptomatic and only 2 cases (2.6%) were with minor manifestations.
Hypotension was manifested in 8 patients (5.3%) on admission. After 12 hours, the percentage of hypotensive cases increased to 14.7%, then decreased to 10%, 6% and 2.6% after 24, 36 and 48 hours respectively. No hypotensive cases were reported after 60 hours.