Background: Aluminium phosphide (AlP) is an affordable and efficient solid pesticide used for grain storage. Objectives: The present study was designed to determine the outcomes of acute aluminium phosphide toxicity and the role of magnesium sulfate as an antidote. Methodology: The present study was conducted on 53 patients admitted to the Minia Poison Control Center with a history of acute aluminium phosphide toxicity to assess the outcomes and role of magnesium sulfate as an antidote. Only 32 patients manifested AlP toxicity, and they were randomly divided into two groups, A and B, each with 16 patients. Group (A) received magnesium sulfate infusion using the bolus protocol of administering 4 g intravenously, 2 g after one hour, and then 1 g/4 h, in addition to other supportive therapies, while group (B) received only supportive therapy. Results: Mortality occurred in 23 cases: 9 cases (56.25%) from group A and 14 cases (87.5%) from group B. In survivors (no. = 9), serum magnesium levels and ABG parameters were significantly higher than those of non-survivors (no. = 23). There was no statistically significant difference between survivors and non-survivors regarding the treatment with Mg sulfate. According to the simple logistic regression test, the riskiest variables were the ingested amount followed by the PO2. Blood PH, PCO2, and serum Mg level had the highest sensitivity (91.3%) in the prediction of mortality, while PO2 was the most specific predictor (specificity = 88.89). Conclusion: Magnesium sulfate therapy did not improve patient outcomes as the mortality rate reached 72% in the current study, so until now, prevention has been the most valuable management strategy. Future studies are required to identify a suitable antidote for AlP toxicity.