Clinical and Pathological Findings on Intoxication by Yellow Phosphorus After Ingesting Firework Cracker: A Rare Case of Autopsy.

Yellow phosphorus is a toxic substance used in the production of firework cracker, fireworks, ammunition and agricultural dung. When ingested, it shows its effects mainly in the liver, the kidneys, and the brain. A four-year-old girl had died as a result of acute hepatic failure caused by ingesting a firework cracker. The case showed high levels of hepatic enzymes, along with non-specific signs such as nausea, vomiting and diarrhea. Autopsy revealed diffuse microvesicular steatosis in the liver and disseminated degeneration in the proximal tubules of the kidneys. In cases with concomitant hepatorenal failure and cardiovascular collapse, death is inevitable. However, when only hepatic failure develops, hepatic transplantation may be lifesaving. Although intoxication from ingesting yellow phosphorus has a very high rate of mortality, forensic cases are extremely rare in the literature.

A Bayesian model for the identification of differentially expressed genes in Daphnia magna exposed to munition pollutants.

In this article we propose a Bayesian hierarchical model for the identification of differentially expressed genes in Daphnia magna organisms exposed to chemical compounds, specifically munition pollutants in water. The model we propose constitutes one of the very first attempts at a rigorous modeling of the biological effects of water purification. We have data acquired from a purification system that comprises four consecutive purification stages, which we refer to as "ponds," of progressively more contaminated water. We model the expected expression of a gene in a pond as the sum of the mean of the same gene in the previous pond plus a gene-pond specific difference. We incorporate a variable selection mechanism for the identification of the differential expressions, with a prior distribution on the probability of a change that accounts for the available information on the concentration of chemical compounds present in the water. We carry out posterior inference via MCMC stochastic search techniques. In the application, we reduce the complexity of the data by grouping genes according to their functional characteristics, based on the KEGG pathway database. This also increases the biological interpretability of the results. Our model successfully identifies a number of pathways that show differential expression between consecutive purification stages. We also find that changes in the transcriptional response are more strongly associated to the presence of certain compounds, with the remaining contributing to a lesser extent. We discuss the sensitivity of these results to the model parameters that measure the influence of the prior information on the posterior inference.

An evaluation of childhood deaths in Turkey due to yellow phosphorus in firecrackers.

Yellow phosphorus (YP) is a powerful protoplasmic poison used in the manufacturing of matches, pest poisons, firecrackers, firework cracker, lights for watches, military ammunition, and agriculture fertilizer. YP is extremely flammable and toxic and easily absorbed from the gastrointestinal tract. In this study, we examined childhood deaths from 1997 to 2012 resulting from the ingestion of firecrackers. The patients ranged from 2 to 15 years of age and were admitted to the hospital with a variety of symptoms. Those that presented with nausea, vomiting, and hypotension rapidly deteriorated and entered a coma. An autopsy was performed in all but one of the 16 cases reviewed. Macroscopically, the livers had a yellowish discoloration with petechial bleeding. Histopathologic examination revealed acute toxic hepatitis. In conclusion, these firecrackers are found in corner shops throughout Turkey, may cause death in children with little warning, and should be banned to prevent further deaths.

Toxicology of explosives and fireworks in small animals.

Intoxication with explosives or fireworks in dogs or cats is not common, but serious toxicosis can result from exposure to different types of explosives depending on the chemical class of explosive involved. This article will discuss the different types of materials/chemicals, clinical signs of toxicosis, and their treatment. Despite the complexities of explosives and plethora of different devices currently in use worldwide, the toxic potential is more easily explained by looking at the relatively short list of chemical classes used to produce these materials. This article combines structurally similar explosives into different groups and focuses on the toxicity of the most commonly available explosives.

A rare cause of poisoning in childhood: yellow phosphorus.

BACKGROUND: Yellow phosphorus poisoning is rare, but when it occurs, it may result in pathological changes in almost all organs of the body, especially the liver, heart, kidney, spleen, and brain, and it has a significant mortality rate. OBJECTIVES: This report presents two cases of poisoning by yellow phosphorus in children. Yellow phosphorus ingestion rarely has been reported among the pediatric population. CASE REPORT: This report presents two cases of yellow phosphorus poisoning in children. The patients were admitted with upper abdominal pain, vomiting, lethargy, and respiratory distress. Laboratory testing revealed hepatotoxicity and coagulation disorder. Yellow phosphorus poisoning was treated with conservative therapy in both patients, and one patient died. CONCLUSION: Yellow phosphorus poisoning is a rare clinical entity and should be considered a dangerous toxic ingestion in children.

Living donor liver transplantation for acute liver failure in pediatric patients caused by the ingestion of fireworks containing yellow phosphorus.

Yellow phosphorus is a protoplasmic toxicant that targets the liver. The ingestion of fireworks containing yellow phosphorus, either by children who accidentally consume them or by adults who are attempting suicide, often results in death due to acute liver failure (ALF). We present the outcomes of 10 children who ingested fireworks containing yellow phosphorus. There were 6 boys and 4 girls, and their ages ranged from 21 to 60 months. One patient remained stable without liver complications and was discharged. Three patients died of hepatorenal failure and cardiovascular collapse, and living donor liver transplantation (LDLT) was performed for 6 patients. The patients had grade II or III encephalopathy, a mean alanine aminotransferase level of 1148.2 IU/L, a mean aspartate aminotransferase level of 1437.5 IU/L, a mean total bilirubin level of 6.9 mg/dL, a mean international normalized ratio of 6.6, a mean Pediatric End-Stage Liver Disease score of 33.7, and a mean Child-Pugh score of 11.3. Postoperatively, 2 patients had persistent encephalopathy and died on the second or third postoperative day, and 1 patient died of cardiac arrest on the first postoperative day despite a well-functioning graft. The other 3 patients were still alive at a mean of 204 days. In conclusion, the ingestion of fireworks containing yellow phosphorus causes ALF with a high mortality rate. When signs of irreversible ALF are detected, emergency LDLT should be considered as a lifesaving procedure; however, if yellow phosphorus toxicity affects both the brain and the heart in addition to the liver, the mortality rate remains very high despite liver transplantation.

White phosphorus poisoning by oral ingestion of firecrackers or little devils: current experience in Ecuador.

BACKGROUND: White phosphorus (WP) is widely used illicitly in fireworks in South America. We report our experience in seven Ecuadorian hospitals. METHODS: A cross-sectional study of patients presented during 2009. Inclusion criteria included: reported oral ingestion of firecrackers (little devils) in any age. Data were gathered using inpatient records and a written survey of the victims. RESULTS: The mean age of the patients was 21.6+/-7.1 years (women 63.5%); 64.7% of cases occurred in November, December and January. In 46% of cases, the number of units ingested was between 1 and 5 (~0.3 to 1.5 g WP), maximum 40 (~12 g). Forty-seven cases attended within 12 hours (55.3%); 5.9% died and 2.4% were readmitted. The remainder were eventually discharged well. Clinical features included: abdominal pain, cramps, diarrhoea, jaundice, nausea and vomiting, abnormal liver enzymes, and coagulation times and hypoglycaemia. CONCLUSIONS: The typical case was an adolescent woman between 16 and 19 years with self-harm around Christmas. There was no specific treatment, but early attendance was associated with improved prognosis. Further studies are necessary to establish an adequate protocol of treatment.

Acute barium toxicity from ingestion of "snake" fireworks.

INTRODUCTION: Ingestion of fireworks has been infrequently reported in the medical literature. We describe a case of acute barium poisoning following firework ingestion. CASE REPORT: A 35-year-old male with a history of severe mental retardation presented with vomiting and diarrhea following ingestion of 16 small fireworks ("color snakes" and "black snakes"). His condition rapidly deteriorated and he developed obtundation, wide complex dysrhythmias, and respiratory failure. Approximately 12 hours following ingestion, his serum potassium level was 1.5 mmol/L with a serum barium level of 20,200 microg/mL (reference range <200 microg/L). The patient eventually recovered with ventilatory support and potassium supplementation. DISCUSSION: Although firework ingestion is uncommon, clinicians should be prepared for potentially severe complications. In the case of barium poisoning, treatment consists of potassium supplementation, along with respiratory and hemodynamic support.

Acute liver failure due to white phosphorus ingestion.

BACKGROUND: White phosphorus is chemical compound available in military ammunition as well as in explosive powder of recreational use. This latter form is commonly found in Latin America and Asia as a main ingredient of gunpowder used to make street firecrackers. Small firecrackers may be ingested accidentally or used as a toxic agent in suicidal attempts which may cause of acute liver failure and death; however the clinical features, incidence and outcome are poorly described in the literature. METHODS: We describe three cases of white phosphorus intoxication with acute liver failure secondary to the consumption of firecrackers. In two cases, ingestion occurred secondary to suicidal attempts and in one, ingestion occurred by accident. In one case, liver injury improved with supportive care, in the other, the patient required liver transplantation and the third case had a fatal outcome. CONCLUSIONS: Clinicians providing care of patients with acute hepatitis of unclear etiology should be aware that the ingestion of firecrackers containing white phosphorus might cause acute liver failure that may require liver transplantation.

An unusual circumstance of internal chemical burn injury - a case report.

Chemical burn injuries including nitric acid injuries are rarely seen in routine clinical practice. In this article, we describe a case of chemical burns due to ingestion of nitric acid in which the history was not of an accidental but of a suicidal nature. Spillage of nitric acid (vitriolage) is frequently reported especially in the third-world countries, but an ingestion injury like this is uncommon and rarely reported.

Methaemoglobinaemia: an explosive case.

Methaemoglobinaemia is an important perturbation to recognise, as untreated it may cause severe tissue hypoxia and cell death. We describe a case of methaemoglobinaemia acquired in an unusual manner, during an explosion at an explosives manufacturing plant.