methemoglobinemia in aluminum phosphide poisoning introduction acute aluminum phosphide alp poisoning is one of the most common causes of acute pesticide poisoning in iran hydrogen phosphide or phosphine gas is produced following reaction of alp with water even at ambient humidity methemoglobinemia is a rare finding following phosphine poisoning in this paper two cases of fatal alp poisoning complicated by methemoglobinemia are reportedcase report two patients presented following suicidal ingestion of alp tablets in the emergency department ed they received gastric lavage with sodium bicarbonate and potassium permanganate both of them received supportive care in each case hematuria and hemolysis were significant events the patients also showed a decrease in o2 saturation in spite of high fio2 methemoglobin levels of 40 and 30 were detected by cooximetry neither patient responded to treatment ascorbic acid in one case methylene blue in the other both patients died due to systemic effects of phosphine poisoningdiscussion and conclusion hemolysis and methemoglobinemia may complicate the course of phosphine poisoning that seems resistant to methylene blue and ascorbic acid therefore other treatments including hyperbaric oxygen therapy and exchange blood transfusion should be considered