Biochemical changes associated with acute phosphorus poisoning (in humans)

An Evaluation of Childhood Deaths in Turkey Due to Yellow Phosphorus in Firecrackers

“…The utility of liver transplantation for managing acute liver failure due to the ingestion of firecrackers containing YP has been recommended since 2009. If yellow phosphorus affects the brain and the heart, in addition to the liver, the mortality rate is high despite liver transplantation . In our case review, macroscopic and microscopic pathologic findings were determined in the livers of four cases that survived 3–11 days.…”

Living donor liver transplantation for acute liver failure in pediatric patients caused by the ingestion of fireworks containing yellow phosphorus

“…Exposure to yellow phosphorus is uncommon in developed countries, whereas acute poisoning can still occur because of suicide attempts by adults and accidental ingestion by children in developing countries. 5,7,9 Yellow phosphorus is a protoplasmic and supertoxic poison that is absorbed rapidly by the gastrointestinal tract after oral ingestion. In an experimental animal study using a lethal dose of a radioactive isotope of phosphorus, phosphorus became particularly concentrated in the liver (up to 70%) within 2 to 3 hours, and lesser amounts were found in the blood (12%), kidneys (4%), pancreas (0.4%), and brain (0.39%).…”

“…Patients progress to the third stage because of the systemic effects of high-dose phosphorus after it has been absorbed. 3,[7][8][9][10][11] If liver transplantation, which is the only treatment during the last stage, is not performed, death is inevitable. 5,7 There is no specific medical test for the diagnosis of yellow phosphorus poisoning, and phosphorus blood levels are not useful for this either.…”

“…The available data 2,3,5,7,8,16 and our experience indicate that patients who ingest fireworks containing yellow phosphorus and have stage III liver damage may not be saved by the removal of phosphorus and general supportive measures, which can be useful in stages I and II of phosphorus poisoning. When ALF has reached stage III (which is irreversible), emergency liver transplantation should be considered the only definitive treatment; however, if yellow phosphorus affects the brain and the heart in addition to the liver, the mortality rate is high (73%-90%) 7,9,10 despite liver transplantation. Hepatic encephalopathy can cover up all the findings of yellow phosphorus neurotoxicity during the third stage; therefore, it is not easy to determine whether encephalopathy results from a hepatic coma or yellow phosphorus neurotoxicity.…”

“…2,3,8 Although yellow phosphorus poisoning may result from industrial accidents in developed countries, it also occurs in adults who are attempting suicide and accidentally by oral intake in children, particularly on festival days, in developing countries. 5,7,9 Unfortunately, the only definitive treatment for ALF due to the ingestion of fireworks containing yellow phosphorus is liver transplantation because no antidote or medical treatment is available to reverse the toxic effects on the liver. However, the impact of living donor liver transplantation (LDLT) and the survival rates of patients with ALF due to yellow phosphorus are not widely known.…”