hydroxyethyl starch could save a patient with acute aluminum phosphide poisoning

a 40-year-old male patient with suicidal ingestion of one tablet of aluminium phosphide was referred to the department of toxicology emergency of baharloo hospital, tehran, iran. the garlic odor was smelled from the patient and abdominal pain and continuous vomiting as well as agitation and heartburn were the first signs and symptoms. systolic and diastolic blood pressures at the arrival time were 95 and 67 mmhg, respectively. gastric lavage with potassium permanganate (1:10,000), and 2 vials of sodium bicarbonate through a nasogastric tube was started for the patient and the management was continued with free intravenous infusion of 1 liter of nacl 0.9% serum plus nahco 3 , hydrocortisone acetate (200 mg), calcium gluconate (1 g) and magnesium sulfate (1 g). regarding the large intravenous fluid therapy and vasoconstrictor administering (norepinephrine started by 5 µg/min and continued till 15 µg/min), there were no signs of response and the systolic blood pressure was 49 mmhg. at this time, hydroxyethyl starch (hes) (6% hetastarch 600/0.75 in 0.9% sodium chloride) with a dose of 600 cc in 6 hours was started for the patient. at the end of therapy with hes, the patient was stable with systolic and diastolic blood pressure of 110 and 77 mmhg, respectively. he was discharged on the 6th day after the psychological consultation, with normal clinical and paraclinical examinations. this is the first report of using hes in the management of alp poisoning and its benefit to survive the patient.