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

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 2 nd 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.

A Study on Clinical Profile and Outcome of Rodenticide Poisoning in South India: A Cross-Sectional Study

“…Both underdeveloped and developing countries have reported intoxication with yellow phosphorus. The intoxication usually occurs after an accidental oral ingestion in developing nations, at the same time ingestion with suicidal tendency is also not rare [3].…”

“…This compound is classified as a highly lethal rodenticide when it is ingested more than1 mg/kg. It is a protoplasmic poison which acts by inhibition of enzymes and protein synthesis [3,4]. Zinc phosphide, which is also used as rodenticide, contains inorganic phosphorous which is hepatotoxic and can be lethal in small doses.…”

“…Phosphine poisoning has the following complications like include fluid loss, hypotension, circulatory failure, reduced cardiac contractility leading to acute renal failure cardiac arrhythmia, pulmonary edema, and congestive heart failure [3][4][5] Acute liver failure is one of the most dangerous side effects of rat killer poisoning. Signs and symptoms of liver failure along with corresponding biomarkers may become abnormal even after 3-4 days of consumption, so meticulous clinical examination for signs of liver failure and repeated liver function tests should be done [4,5] Cases of poisoning with yellow phosphorus can remain asymptomatic initially, minimal recovery can be seen after 2 or 3 days, and then, features of acute hepatic failure may occur [3]. Specific antidote has not been discovered and hence supportive care is the mainstay of treatment.…”