Successful rescue of a patient with extensive lethal-dose aluminum phosphide poisoning complicated by multiple organ dysfunction syndrome.

Aluminum phosphide poisoning is a highly lethal toxicological emergency associated with an extremely high mortality rate, and no specific antidote is currently available. Aluminum phosphide rapidly releases phosphine gas after coming into contact with gastric acid, which strongly inhibits mitochondrial cytochrome c oxidase, leading to severe cellular metabolic disorder, lactic acidosis, refractory shock, and progressive multiple organ dysfunction syndrome. In severe cases, the mortality rate can approach 100%. We report the case of a man in his early 40s who intentionally ingested 25.2 g of aluminum phosphide, equivalent to approximately 16 times the human lethal dose (based on a lethal dose of 1.5 g). The patient rapidly developed fulminant multiple organ dysfunction syndrome, including refractory cardiogenic shock, acute respiratory distress syndrome, acute kidney injury, liver dysfunction, hypocalcemia, and secondary ventilator-associated pneumonia caused by Citrobacter koseri infection. He received a series of timely critical interventions, including ultra-early gastric lavage with liquid paraffin, sequential hemoperfusion, continuous venovenous hemofiltration, mechanical ventilation with prone positioning, circulatory support, corticosteroids, and targeted antimicrobial therapy. The patient achieved complete clinical recovery and was discharged 18 days after admission. No organ or neurological sequelae were observed at the 1-month follow-up. This rare and successful rescue demonstrates that even ultra-severe aluminum phosphide poisoning can be reversed with standardized, sequential, and comprehensive critical care support without relying on advanced life-support devices such as extracorporeal membrane oxygenation. This study provides a practical and valuable therapeutic strategy for the management of severe aluminum phosphide poisoning in resource-limited clinical settings.