20 Predictors for Need for Liver Transplants in Acute Zinc Phosphide Poisoning

Abstract

failure (ALF). In India, an unusual but not an uncommon cause of ALF is the ingestion of rodenticides containing zinc phosphide (Ratol ®). Overall survival following Ratol ® poisoning is poor without LT. Aim: The aim of this study was to identify clinical predictors to distinguish patients most likely to require LT following Ratol ® ingestion. Method: Retrospective data analysis of 30 patients admitted between January 2006 and April 2011 following Ratol ingestion was performed. Nine underwent living donor liver transplant (LDLT) and 6 patients died without transplant (Group I). Fifteen patients who had very minimal exposure to the poison recovered without transplant (Group II). The 2 groups were compared with identify prognostic factors that could predict the need for LT. Result: The average time interval between consumption of the poison and ALF was 6.5 days. The average model for end stage liver disease (MELD) score for Group I was 38 compared with 18 in Group II. The median INR value (8 in Group I vs 3 in Group II) and the median total bilirubin value (13 in Group I vs 5 in Group II) were significantly lower in the group that recovered without transplant. All patients who developed encephalopathy either died or required LT. A MELD score of over 31 on day 6 and the onset of encephalopathy at any time following ingestion were the reliable predictors of the need for LT. Conclusion: MELD score of 31 on the sixth day or the presence of encephalopathy at any time after ingestion of Ratol ® is the strong predictor of mortality without LT.

A case of severe zinc phosphide poisoning

“…Acute hepatic failure has also been reported which is often considered to be fatal and may warrant liver transplantation [8]. Severe prolonged hypoglycaemia has been reported following ZnP poisoning possibly due to impairment of glycogenolysis and gluconeogenesis [9].…”

Acute on chronic liver failure presentation of zinc phosphide poisoning: a concept elucidating case report

“…A study from Kerala found MELD score of 31 on the sixth day or the presence of encephalopathy at any time after ingestion of zinc phosphide as a strong predictor of mortality without liver transplantation. 10 Liver transplantation is a potential therapy for patients who do not improve with supportive measures. However, the selection criteria for liver transplantation in ACLF needs to be better defined.…”