Skeletal age assessment; are we being fair to our children?

Zinc Phosphide is an inorganic chemical that is used to control rats, mice, voles, ground squirrels, prairie dogs, nutria, muskrats, feral rabbits and gophers.1 Zinc Phosphide doses of the order of 4000 to 5000 mg have been fatal. It can enter the blood stream causes pulmonary oedema and severe liver, kidney, CNS, and myocardial injury.2 Distal Renal Tubular Acidosis is an inability to maximally acidify the urine due to reduce H+ secretion in the distal nephron. The diagnosis of type 1 RTA is suggested by finding a hyperchloraemic normal anion gap metabolic acidosis associated with a urine pH > 5.5 despite plasma [HCO3] < 15 mmol/L.3 We suggest, specific recommendations for patients with zinc phosphide poisoning with tachypnea. They should be screened for metabolic acidosis (especially renal tubular acidosis) with arterial blood gas analysis. Respiratory support and intravenous fluid resuscitation with sodium bicarbonate treatment should be considered.