Background: Aluminum phosphideas pesticide commonly used to protect crops from pests. Despite the limited number of cases of poisoning with this substance, it is important due to the high risk of being fatal. The major cause of the poisoning is suicide attempt. Due to the lack of specific treatment in poisoning, taking more than 500 mg is fatal.Case Report: The patient was a 16-year-old woman who attempted suicide by consuming some 4.5gram aluminum phosphide tablets. Within half an hour after consumption she had vomiting and nausea then smoking cigar, followed closely by smoking in her mouth flames around his mouth is created which will burn (grade II). Subsequently she had argument with her husband and injured her right ear. During the admission she was alert, 2nd degree burn were observed on the upper lip and around the mouth and nose and ears areas. Physical examination was normal, when she arrived she had severe hypotension and her oxygen saturation was 69% with tachycardia. The patient was immediately intubated and received mechanical ventilation. After installing Nasogastric tube, gastric lavage was done with potassium permanganate and bicarbonate. At Arterial Blood Gas (ABG), severe metabolic acidosis (pH 6.9) and a chest X-ray, diffuse lung opacities was seen. Blood test showed that there was a leukocytosis (22, 000). Treatment was given Saline, high dose inotrope drugs (norepinephrine and dopamine), bicarbonate, calcium gluconate, magnesium sulfate hydrocortisone. Burns around the mouth was dressing after admission. On the third day the patient was alert and complained of pain in the right ear and hearing loss.9 days after admission, the patient was discharged well with complication of sensory neural hearing loss (unrelated to slap injury).Conclusion: Despite the extreme virulence of the Aluminum phosphide (rice tablets), especially in high doses, conventional therapeutic measures can sometimes unexpected ways leading to improved patient. The patient's well general condition was discharged with remained hearing loss in her right ear, despite the very poor prognosis. It is recommended that phosphine gas research on the possible impact of hearing loss further.