Background: Phosphide poisoning is becoming a more prevalent self-poisoning compound in Egypt. Within the first 12 to 24 hours after phosphide exposure, most deaths happen, mainly because of cardiovascular toxicity. Peripheral vascular failure and myocardial ischemia are listed as the causes of mortality in these patients; however, the underlying mechanisms are still unclear. Aim of the Work: This study aimed to determine the magnitude of cardiovascular affection in patients who were intoxicated with aluminum phosphide (ALP) and to assess the role of some investigational parameters such as levels of methemoglobin (Met-Hb), pseudocholinesterase (PCE), and troponin I (Tn-I) as predictors for mortality and their correlation with patients' outcomes. Subjects and Methods: A clinical prospective comparative study between survivors and non-survivors was conducted on 60 ALP-intoxicated patients of both sexes who were admitted to “The Toxicology Unit of Emergency Hospital Mansoura University, Egypt. Results: There were highly statistically significant differences between survivors and non-survivors regarding Met-Hb, and Tn-I levels with no statistically significant differences regarding PCE level. Met-Hb and Tn-I were more sensitive and more specific than PCE in differentiating non-survived cases. Conclusions: It can be concluded that there is a strong correlation between the rise in blood levels of Met-Hb and Tn-I levels in ALP-poisoned patients. In addition, both could be used as predictors of mortality and differentiation of cases with poor prognosis at the time of admission in such highly fatal poisoning.