Introduction: Aluminum Phosphide (ALP) is one of the most common sources of pesticide toxicity. Mortality is remarkably high due to immediate release of lethal phosphine gas which causes severe oxidative stress. Unfortunately, treatment is mainly supportive and there is no specific antidote. Studies on the beneficial effects of N-acetylcysteine (NAC) in acute ALP poisoning are controversial. Aim of the Work: This study aimed to assess the benefits of NAC in association with adequate supportive treatment in the management of acute ALP intoxication and exploring its effect on duration of hospitalization, mortality rate and survival time among Egyptian patients admitted to “Toxicology Unit of Emergency Hospital Mansoura University". Subjects and Methods: This was a randomized clinical trial carried out on 60 intoxicated patients of both sexes, presented within 6 hours from ALP intoxication. All participants were divided into two groups; “NAC treated group" and “NAC non treated group". Results: The duration of hospitalization has diminished significantly among NAC treated group (P<0.001*). There was significant increase in the mean overall survival duration (P=0.023*) in the 1st 24 hrs. of intoxication with significant decrease in the mortality rate among NAC treated group (P=0.05*). Moreover, survival time before death was significantly prolonged among expired patients in NAC treated group (P<0.001*). Conclusions: The present study suggests that, early administration of high doses of NAC along with adequate supportive treatment may have a survival benefit over supportive treatment alone for the outcome in such highly fatal ALP poisoning. Keywords: Aluminum Phosphide, Poisoning, NAC, Survival Time.