Acute liver failure due to zinc phosphide containing rodenticide poisoning: Clinical features and prognostic indicators of need for liver transplantation

Abstract

Zinc phosphide (ZnP) containing rodenticide poisoning is a recognized cause of acute liver failure (ALF) in India. When standard conservative measures fail, the sole option is liver transplantation. Records of 41 patients admitted to a single centre with ZnP-induced ALF were reviewed to identify prognostic indicators for requirement of liver transplantation. Patients were analyzed in two groups: group I (n = 22) consisted of patients who either underwent a liver transplant (n = 14) or died without a transplant (n = 8); group II (n = 19) comprised those who survived without liver transplantation. International normalized ratio (INR) in group I was 9 compared to 3 in group II (p < 0.001). Encephalopathy occurred only in group I. Model for End-Stage Liver Disease (MELD) score in group I was 41 compared to 24 in group II (p < 0.001). MELD score of 36 (sensitivity of 86.7 %, specificity of 90 %) or a combination of INR of 6 and encephalopathy (sensitivity of 100 %, specificity of 83 %) were the best indicators of mortality. Such patients should undergo urgent liver transplantation.

Hepatotoxicity due to zinc phosphide poisoning in two patients: role of N‐acetylcysteine

“…In agreement with this study, it has been shown that it could cause acute liver failure (ALF), and when standard conservative treatment fails, the only option to save the life of ZnP‐poisoned patients with irreversible ALF is liver transplantation 10. Consistent with this study, other studies have shown that the most common clinical signs of ZnP‐poisoned patients include vomiting (100%), abdominal pain (100%), palpitation and sweating (80%), dyspnea and tachypnea (75%), metabolic acidosis (60%), shock (40%), and hypotension (40%) 11.…”

Successful Treatment of Heart Failure Due to Simultaneous Poisoning with Aluminum Phosphide and Zinc Phosphide: A Case Report

“…The most important dissimilarity of ZnP and AlP poisoning is the relatively longer time of symptom appearance upon poisoning by ZnP. Also, development of acute liver failure has been almost exclusively reported in the first week after ZnP poisoning (16).…”

Successful management of zinc phosphide poisoning: possible benefit of virgin olive oil

“…A recent report of phosphine poisonings in Europe indicated that approximately 28% were by intentional ingestion and 65% were by accidental inhalation [2]. Renal failure and cardiac failure due to toxic cardiomyopathy were the commonest secondarily affected systems leading to rapid mortality [3].…”

“…It also disturbs the mitochondrial morphology, inhibits oxidative respiration by 70% and causes a severe drop in mitochondrial membrane potential, causing, in turn, the cells to die rapidly [3]. Mitochondrial cytochrome C oxidase inhibition may also lead to pulmonary and cardiac toxicity.…”

“…Metabolic acidosis must be treated by administering sodium bicarbonate. Activated charcoal, sorbitol suspension or sodium bicarbonate solution should be administered orally [3].…”