Case report: acute phosphine inhalation poisoning in a patient with Down's syndrome

作者：Xin Yu, Jianlong Zhang, Jiangjian Xu, Keqi Dong, Lu-Shen Jin, Xuebin Wen, Xiaojing Zhou · 发表于：International Journal of Emergency Medicine · 年份：2026 · DOI：10.1186/s12245-026-01132-1 · 研究领域：Medicine

Background Phosphine, a highly potent insecticide, can cause damage to multiple physiological systems when inhaled by humans, including the nervous, circulatory, and urinary systems. Currently, there is no effective antidote for phosphine poisoning, which highlights the importance of systematic and effective supportive treatment. Case presentation This paper presents a case of a patient with Down syndrome who had a history of similar gas poisoning and was exposed to high-concentration phosphine gas within 10 min, resulting in inhalation poisoning and shock. Upon admission to our hospital, the patient’s left ventricular ejection fraction (LVEF) dropped to 34% (55%-75%), lactate dehydrogenase (LDH): 586 U/L (120–250 U/L), and creatine kinase-MB (CK-MB): 12.75 ng/ml (0–5 ng/ml), indicating severe cardiac function impairment. Treatment included mechanical ventilation and PICCO-guided hemodynamic management. During treatment, the patient’s whole-blood lactate concentration peaked at 12.5 mmol/L (nearly eight times the normal range), for which continuous renal replacement therapy (CRRT) was administered. Additionally, the comprehensive application of continuous norepinephrine infusion for circulatory maintenance, targeted correction of acidosis, and administration of metaraminol and dobutamine for inotropic support were crucial for improving the patient’s prognosis. Ultimately, the patient was successfully cured. Conclusions In this case, disproportionate myocardial injury relative...