Role Of Plasmapheresis In 3% Yellow Phosphorus Poisoning And Its Outcome
Keywords:
Yellow phosphorus poisoning, plasmapheresis, acute liver injury, liver failure, rodenticide toxicity, coagulopathy, therapeutic plasma exchange, toxic hepatitis, poisoning management, prognostic factorsAbstract
Background and Objectives: Yellow phosphorus, commonly found in rodenticides, is a highly toxic substance frequently used in developing countries like India. Poisoning due to ingestion is often accidental or intentional, with a lethal dose of approximately 1 mg/kg. There is no specific antidote, and treatment primarily involves supportive care. This study evaluates the role of plasmapheresis in managing acute liver injury caused by yellow phosphorus poisoning.
Methods: A retrospective case analysis was conducted at VMKVMCH, Salem, Tamil Nadu, on patients admitted with yellow phosphorus poisoning between January 2021 and March 2022. Medical records of these patients were reviewed. Baseline vital parameters and laboratory investigations (liver biomarkers, renal parameters, serum electrolytes, coagulation profile, arterial blood gas analysis, and imaging studies). Daily monitoring of blood investigations and clinical status. Statistical analysis using SPSS version 23, with numerical data presented as mean, standard deviation, and categorical data as percentages.
Results: Early plasmapheresis (within 24 hours of ingestion) was associated with better clinical outcomes. Plasmapheresis reduced bilirubin, SGOT, SGPT, and INR levels significantly (p<0.05), though liver function parameters showed temporary elevation post-procedure. It was effective in preventing rapid deterioration, improving initial recovery, and stabilizing coagulation parameters. The overall survival rate was 67% in patients receiving plasmapheresis compared to a previously reported 76.2% mortality rate with standard care.
Conclusion: Yellow phosphorus poisoning predominantly affects young adults, with a female preponderance. Acute liver injury develops within 3–4 days post-ingestion, and early plasmapheresis significantly improves prognosis. Patients presenting within 24 hours of poisoning respond well to treatment, reducing the need for liver transplantation. Plasmapheresis plays a crucial role in managing toxin-mediated acute liver injury and should be considered as an early therapeutic intervention.
Downloads
Metrics
References
Gargi J, Tejpal HR, Chanana A, Rai G, Chaudhary R. A retrospective autopsy study of poisoning in the northern region of Punjab. J Punjab Acad Forens Med Toxicol. 2008;8(2):17-9.
Ahuja H, Mathai AS, Pannu A, Arora R. Acute poisonings admitted to a tertiary level intensive care unit in northern India: patient profile and outcomes. J Clinic Diag Res. 2015;9(10):UC01.
Suneetha DK, Inbanathan J, Kannoth S, Reshma PK, Shashank MS. Profile of rat killer poisoning cases in a tertiary care hospital at Mysore. Int J Sci Study 2016;3(12):264–267.
Fernandez OU, Canizares LL. Acute hepatotoxicity from ingestion of yellow phosphoruscontaining fireworks. J Clin Gastroenterol 1995;21(2):139–142. DOI: 10.1097/00004836-199509000-00015
Alaga Venkatesan, et al. A study on the role of n-acetyl cysteine in yellow phosphorous poisoning (ratol) and postmortem toxicological findings. International Journal of Current Research Vol. 11, Issue, 01, pp.672-675, January, 2019 DOI: https://doi.org/10.24941/ijcr.33948.01.2019.
Varghese J, Joshi V, Bollipalli MK, Malleeswaran S, Patcha R, Nair H, Vij V, Sachan D, Subramanian P, Jain M, Venkataraman J. Role of therapeutic plasma exchange in acute liver failure due to yellow phosphorus poisoning. Indian J Gastroenterol. 2020 Dec;39(6):544-549. doi: 10.1007/s12664-020-01095-y. Epub 2021 Jan 6. PMID: 33409946; PMCID: PMC7787244.
Mathew J, Gnanaraj J, Basavarajegowda A, Venkateswaran R. Plasmapheresis in lethal yellow phosphorus poisoning: a scope for recovery. BMJ Case Rep. 2021 Apr 21;14(4):e239676. doi: 10.1136/bcr-2020-239676. PMID: 33883110; PMCID: PMC8061805
Appavu, Vinoth & Anthirias, Deborah & Dhanaraj, Haripriya & Lakshmanan, Mageshwaran & Ananthakumar, Sujitha & K, Swathi & Vinayagam, Swathy & Sekar, Chouthri. (2019). Yellow phosphorous poisoning: an observational study from a tertiary care hospital. Journal of Evidence Based Medicine and Healthcare. 6. 996-1002. 10.18410/jebmh/2019/208.
Ates M, Dirican A, Ozgor D, Aydin C, Isik B, Ara C, et al. Living donor liver transplantation for acute liver failure in pediatric patients caused by the ingestion of fireworks containing yellow phosphorus. Liver Transpl. 2011;17:1286–91. [PubMed] [Google Scholar]
Krishnakumar N, Krishnakumar S, Dalus MR, Balamugesh T. Yellow phosphorous poisoning--smoking stool syndrome. J Assoc Physicians India. 1997 Nov;45(11):885-6.PMID: 11229195
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
