N-Acetylcysteine, a Boon for Yellow Phosphorus-Induced Acute Liver Failure? A Case Report

Abstract

Rat killer, in the form of a paste, is a commonly used rodenticide in India. It contains 3% yellow phosphorus, which is a local and a systemic toxin that damages all tissues it contacts. The lethal dose of yellow phosphorus is about 1 mg/kg of body weight. We present a case report of a 30-year-old female patient with an alleged history of intake of 30 g rat killer paste mixed with one glass juice with suicidal intent. She presented with clinical features of acute liver failure (ALF) and was treated with N-acetylcysteine (NAC) infusion with other supportive therapy and recovered completely within 13 days. Poisoning with yellow phosphorus needs to be studied in the aspect of treatment, due to the lack of any specific antidote. The patient factors that help in the recovery also need to be investigated. Although highly lethal, the recovery of ALF due to yellow phosphorus-containing rodenticide is possible. Early intravenous administration of NAC, which acts as glutathione substitute, anti-inflammatory agent, and anti-oxidant could contribute to complete resolution of ALF in yellow phosphorus poisoning.