Phosphine interferes with enzymes and protein synthesis, primarily in the mitochondria of heart and lung cells. Metabolic changes in heart muscle
cause cation disturbances that alter transmembrane potentials. Ultimately, cardiac arrest, peripheral vascular collapse and pulmonary edema can occur.
Pulmonary edema and pneumonitis are believed to result from direct cytotoxicity to the pulmonary cells. In fatal cases, centrilobular necrosis of the
liver has also been reported.
Most deaths occur within the first 12 to 24 hours after exposure and are cardiovascular in origin. If the patient survives the initial 24 hours, the
ECG typically returns to normal, indicating that heart damage is reversible. Deaths after 24 hours are usually due to liver failure.
|