ABSTRACT
Yellow phosphorus (YP) containing rodenticides is a readily available poison that may be accidentally or deliberately ingested, leading to symptoms ranging from simple gastrointestinal symptoms to fulminant hepatic failure, depending on the amount ingested. As there is no specific antidote, the treatment requires early gastric lavage and institution of supportive measures such as acetyl cysteine infusion and Vitamin K. Progression to fulminant hepatic failure is characterized by rapid deterioration of liver function tests, worsening coagulopathy, and sensorium. The only definitive treatment at this stage is a liver transplant and therapeutic plasma exchange (TPE) can serve as a bridge therapy until a compatible liver donor is found. We present a case of YP-containing rodenticide poisoning, in which the patient progressed to fulminant hepatic failure despite aggressive supportive therapy and was successfully managed with TPE until liver transplantation.
ABSTRACT
Background: Yellow phosphorus containing rodenticide poisoning are common in Adult critical care. They cause coagulopathy and liver cell failure in humans. Till date, only liver transplants had been advocated as the final treatment of fulminant liver failure occurring as a complication of rodenticide poisoning. In this study, an innovative Treatment approach was given to liver cell failure cases who had consumed yellow phosphorus paste.Methods: Retrospective analysis of case records of liver cell failure cases due to the consumption of phosphorus containing Rodenticide poisonings, were analysed for a period of 1 year from January 2018 to January 2019 in a public hospital. Medical case records were obtained from records department and Postmortem registers. Symptoms, signs, investigations, treatments, complications, and outcomes were tabulated.Results: Total 11 cases were studied. 8 cases of liver cell failure and coagulopathy in whom therapeutic heparin free plasmapheresis was given, recovered completely from liver cell failure. A significant drop in Haemoglobin, platelet count, PT INR Ratio and rise in serum alkaline phosphatase, were the predictable factors used for the intervention of therapy with 5 cycles of heparin free plasmapheresis to eliminate toxic effects of phosphorus on liver cells and in the blood. A comparative analysis of untreated cases (n=3) vs treated with plasmapheresis (n=8), showed a significant statistical difference (P <0.005) in outcomes with a degree of freedom=2.Conclusions: Plasmapheresis can be a therapeutic treatment for liver cell failure caused due to the consumption of yellow phosphorus. Predictable factors for impending liver cell failure in whom plasmapheresis will be of benefit are dependent upon prothrombin time, INR ratio, Liver enzymes and time interval between consumption and onset of liver cell failure.
ABSTRACT
A.Conclusion The inhalation of yellow phosphorus and its compounds in rats may induce intoxication of rats with manifestations of ALI/ARDS.Xuebijing injection and decadron have therapeutic effects on such intoxication,then Xuebijing injection combined with both decadron can decrease decadron dosage.
ABSTRACT
This study was undertaken to examine the possible effects of Artesunate(Art) on the hepatic reduced glutathione(GSH) content in normal and hepatotoxin - poisoned mice. It was demonstrated that Art given ip( 100mg?kg-1or 200mg?kg-1 ? 3)to mice had a signifcant protection against hepatic GSH deplection induced by acetaminophen and yellow phosphorus, andthat Art also caused a marked increase of the hepatic GSH content in fasting mice at the dose of 200mg ? kg-1. These results indicate that Art can help the liver detoxication of toxic metabolits in mice.