Background: Aluminum phosphide (ALP) and zinc phosphide pesticides are widely used as grain preservatives in Egypt. It was associated with high morbidity and mortality rates. Aim: To investigate the pattern and predictors of mortality related to aluminum and zinc phosphide poisoning. Methods: A two years prospective study was conducted on 399 patients with acute aluminum and zinc phosphide poisoning (124 non-survivors and 275 survivors) who were admitted to Menoufia University Poison and Dependence Control center (MPCC), during the period from 1st of July 2016 to the end of June 2018. For each patient, demographic and poisons data were taken. Also, clinical examination, laboratory investigations, ECG and Echocardiography were performed. Results: Phosphide poisoning predominated among cases aged < 18 years (46.8%), females (68.7%), students (48.9%) who attempted suicide (92.2%). The majority of non-survivors took aluminum phosphide tablets (97.6%) while most of survivors took zinc phosphide powder (78.5%). There was a significant difference as regards poisoning severity score (PSS), severe PSS among non-survivors (91.9%) while mild PSS among survivors (77.4%). Severe left ventricular dysfunction was the most predicting factor for mortality in the studied cases (OR= 9.35; CI: 1.156-5.26, P <0.001) followed by higher dose, need for mechanical ventilation, more than 2 hours' time delay, acidosis and hypotension. Conclusion: The mortality from aluminum and zinc phosphide poisoning can be predicted by intake one tablet or more of AlP with delayed time from intake to seek medical care, left ventricular dysfunction, hypotension and acidosis. These finding necessitate the need for public health policies to restrict the accessibility and use of phosphides in Egypt with the awareness of the public to the high fatality of these poisons.