Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2020.146
Autopsy and Case Reports
Article / Autopsy Case Report

A fatal case of multi-organ failure in acute yellow phosphorus poisoning

Jai Prakash Soni; Pankaj Suresh Ghormade; Swapnil Akhade; Krishnadutt Chavali; Bedanta Sarma

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Abstract

Phosphorus is a nonmetallic irritant used in various sectors like rodenticide, firecracker industries, match industries, and fertilizers. Phosphorus poisoning is responsible for deaths among children and adults. Accidental yellow phosphorus poisoning is frequently reported in children, whereas suicidal consumption is not uncommon amongst adults. Herein, we present the case of a 30-year-old female patient who ingested Ratol paste containing yellow phosphorus in an attempt to commit suicide. Her initial chief complaints were nausea, vomiting along with loose motion during hospitalization, followed by a symptomless phase with stable vitals on the 2nd day, and managed conservatively. She took discharge against the medical advice. Later on, she was readmitted in the same hospital, after two days, complaining of generalized weakness, bodily pain, drowsiness, loss of appetite, and breathing difficulties. She developed severe complications due to the intoxication and died. An autopsy was performed. The histopathological and the toxicological examination were carried out. We found characteristic features in different organs due to yellow phosphorus toxicity. We concluded the cause of death as hepatic encephalopathy and multi-organ dysfunction syndrome caused by the yellow phosphorus poisoning.

Keywords

Phosphorus, Hepatic encephalopathy, Multiple organ failure

References

Food and Agriculture Organization of the United Nations (FAO). India at a glance. Rome: FAO; 2019 [cited 2019 Sep 23]. Available from: http://www.fao.org/india/fao-in-india/india-at-a-glance/en/

Brent J, Wallace KL, Burkhart KK. Phosphorus. In: Brent J, Wallace KL, Burkhart KK, Phillips SD, Donovan JW, editors. Critical Care Toxicology – Diagnosis and management of the critically poisoned patient. Philadelphia, PA: Elsevier Mosby; 2005. pp. 851-61.

Karanth S, Nayyar V. Rodenticide-induced hepatotoxicity. J Assoc Physicians India. 2003;51:816-7. [PMID:14651148]

Nalabothu M, Monigari N, Acharya R. Clinical profile and outcomes of rodenticide poisoning in tertiary care hospital. IJSRP. 2015;5:1-12.

Chikkaveeraiah SK, Marijayanth M, Reddy PK, Kaluvakuri S. Clinical profile and outcome of rodenticide poisoning in patients admitted to a tertiary care teaching hospital in Mysore, Karnataka. India. Int J Res Med Sci. 2016;4:5023-7. [https://doi.org/10.18203/2320-6012.ijrms20163811].

González-Andrade F, López-Pulles R. White phosphorous poisoning by oral ingestion of firecrackers or little devils: Current experience in Ecuador. Clin Toxicol (Phila). 2011;49(1):29-33. [https://doi.org/10.3109/15563650.2010.547860]. [PMID:21288149]

Ghoshal AK, Porta EA, Hartroft WS. The role of lipo-peroxidation in the pathogenesis of fatty livers induced by phosphorus poisoning in rats. Am J Pathol. 1969;54(2):275-91. [PMID:5765566]

Kannan K. Modi A textbook of medical jurisprudence and toxicology. 25th ed. New Delhi: Lexis Nexis Butterworths Wadhwa; 2016. p. 57.

Eldad A, Simon GA. The phosphorous burn - a preliminary comparative experimental study of various forms of treatment. Burns. 1991;17(3):198-200. [https://doi.org/10.1016/0305-4179(91)90103-N]. [PMID:1892550]

Konjoyan TR. White phosphorus burns: Case report and literature review. Mil Med. 1983;148(11):881-4. [https://doi.org/10.1093/milmed/148.11.881]. [PMID:6419161]

Mozingo DW, Smith AA, McManus WF, Pruitt BA Jr, Mason AD Jr. Chemical burns. J Trauma InjCrit Care. 1988;28(5):642-7. [https://doi.org/10.1097/00005373-198805000-00014]. [PMID:3367407]

Mohideen SK, Kumar KS. Should ratol paste be banned? Indian J Crit Care Med. 2015;19(2):128-9. [https://doi.org/10.4103/0972-5229.151026]. [PMID:25722560]

Lakshmi CP, Goel A, Basu D. Cholestatic presentation of yellow phosphorus poisoning. J Pharmacol Pharmacother. 2014;5(1):67-9. [https://doi.org/10.4103/0976-500X.124430]. [PMID:24554916]

Lee WM, Larson AM, Stravitz RT. AASLD position paper: the management of acute liver failure: Update. Hepatology. 2011;55:965-67.

Saoji AA, Lavekar AS, Salkar HR, Pawde GB, Tripathi SS. A case on suicidal poisoning associated with Ratol and a perspective on yellow phosphorus poisoning. Int J Re Sci&Techi. 2014;10:223-5.

McCarron MM, Gaddis GP, Trotter AT. Acute yellow phosphorus poisoning from pesticide pastes. Clin Toxicol. 1981;18(6):693-711. [https://doi.org/10.3109/15563658108990295]. [PMID:7273676]

Tafur AJ, Zapatier JA, Idrovo LA, Oliveros JW, Garces JC. Bone marrow toxicity after yellow phosphorus ingestion. Emerg Med J. 2004;21(2):259-60. [https://doi.org/10.1136/emj.2003.007880]. [PMID:14988373]

Fernandez OU, Canizares LL. Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks. J Clin Gastroenterol. 1995;21(2):139-42. [https://doi.org/10.1097/00004836-199509000-00015]. [PMID:8583080]

Santos O, Restrepo JC, Velásquez L, et al. Acute liver failure due to white phosphorus ingestion. Ann Hepatol. 2009;8(2):162-5. [https://doi.org/10.1016/S1665-2681(19)31799-5]. [PMID:19502664]

Agency for Toxic Substances and Disease Registry. Toxicological Profile for White Phosphorus. Atlanta: ATSDR; 1997 [cited 2005 Nov 29]. Available from: http://www.atsdr.cdc.gov/toxprofiles/tp103.html

 

 

 


Publication date:
01/30/2020

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