Rat Killer Poisoning vs Liver Damage: A View in South Indian Patients of Tertiary Care Center

Venugopal, Radhika; Narayanasamy, Krishnasamy; Chezhian, A.; R, Senthil Kumar; Jasmine, J. Janifer

doi:10.4172/2161-069x.1000569

Cited by 6 publications

(13 citation statements)

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“…16 Lethal dose of 13.42 AE 7.069 g of household rodenticide has been reported, similar to spontaneous survival with dose <17.5 g in our series. 17 The demographic profile of our patients is consistent with other studies. 18 Clinical manifestations of YPMP poisoning may be divided into three phases (Table 5), which are consistent with our series, except a very low rate of GI toxicity in our patients, probably due to late presentation beyond the first two phases (at about 3 days).…”

Section: Discussionsupporting

confidence: 92%

“…Impulsive suicidal consumption with alcohol or water (as death is believed to be painless), accidental consumption by children (as directions for use include applying the paste on bread) and by adults (mistaken for toothpaste) have been reported 16 . Lethal dose of 13.42 ± 7.069 grams of household rodenticide has been reported, similar to spontaneous survival with dose <17.5 grams in our series 17 .…”

Section: Discussionsupporting

confidence: 90%

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Acute Liver Failure Secondary to Yellow Phosphorus Rodenticide Poisoning: Outcomes at a Center With Dedicated Liver Intensive Care and Transplant Unit

Mohanka

Rao

Shah

et al. 2020

Journal of Clinical and Experimental Hepatology

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Background: Accidental or suicidal poisoning with yellow phosphorus or metal phosphides (YPMP) such as aluminum (AlP) zinc phosphide (Zn 3 P 2) commonly causes acute liver failure (ALF) and cardiotoxicity. These are used as household, agricultural, and industrial rodenticides and in production of ammunitions, firecrackers, and fertilizers. In absence of a clinically available laboratory test for diagnosis or toxin measurement or an antidote, managing their poisoning is challenging even at a tertiary-care center with a dedicated liver intensive care unit (LICU) and liver transplant facility. Methods: Patients with YPMP-related ALF were monitored using standardized clinical, hemodynamic, biochemical, metabolic, neurological, electrocardiography (ECG), and sequential organ failure assessment (SOFA) score and managed using uniform intensive care, treatment, and transplant protocols in LICU. Sociodemographic characteristics, clinical and biochemical parameters, and scores were summarized and compared between 3 groups i.e. spontaneous survivors, transplanted patients, and non-survivors. Predictors of spontaneous survival and the need for liver transplant are also evaluated. Results: Nineteen patients with YPMP-related ALF were about 32 years old (63.2% females) and presented to us at a median of 3 (0-10) days after poisoning. YPMP-related cardiotoxicity was rapidly progressive and fatal, whereas liver transplant was therapeutic for ALF. Spontaneous survivors had lower-dose ingestion (<17.5 g), absence of cardiotoxicity, < grade 3 hepatic encephalopathy (HE), lactate < 5.8, SOFA score < 14.5, and increase in SOFA score by < 5.5. Patients with renal failure need for continuous veno-venous hemodiafiltration (CVVHDF) and King College criteria positivity on account of prothrombin time and international normalized ratio (PT-INR) > 6.5 had higher mortality risk. Patients undergoing liver transplant and with spontaneous recovery required longer intensive care unit and hospital stay. At median follow-up of 3.4 (2.6-5.5) years, all spontaneous survivors and transplanted patients are well with normal liver function. Conclusions: Early transfer to a specialized center, preemptive close monitoring, and intensive care and organ support with ventilation, CVVHDF, plasmapheresis, and others may maximize their chances of spontaneous recovery, allowing accurate prognostication and a timely liver transplant. (J CLIN EXP HEPATOL xxxx;xxx:xxx)

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Acute Liver Failure Secondary to Yellow Phosphorus Rodenticide Poisoning: Outcomes at a Center With Dedicated Liver Intensive Care and Transplant Unit

Mohanka

Rao

Shah

et al. 2020

Journal of Clinical and Experimental Hepatology

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“…Controlling rodents is imperative as they are vectors for the spread of disease, destroy crops/grains, and multiply rapidly. [1]…”

Section: Introductionmentioning

confidence: 99%

Role and effects of n-acetylcysteine in rat killer (rodenticide) poisoning

Chandravanshi

Kori

Tembhurnikar

et al. 2021

Medico Research Chronicles

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Introduction:-Rodenticide is one of the pesticides and heterogeneous substances used to kill rats. Rodenticide poisoning is a major health problem in Asian countries, particularly the mode of self-poisoning, prevalent in India. It causes hepatotoxicity and no antidote has been found. N-acetylcysteine (NAC) is a powerful antioxidant and used in the treatment of acetaminophen-induced hepatotoxicity. The main objectives of this study were to determine the role of NAC in liver impairment rodenticide poisoning patients. Methods:-Patients who ingested rat killer poison and age >15 years were included in the study. Patients having jaundice, liver disease, and age <15 years were excluded from the study. Results:-Out of 50 patients. 27 (54%) were females and 23 (46%) were males. Age group between 21-30 years contributes the highest 20 (40%). The majority of types of rodenticide compounds consumed by patients were paste 29 (58%) and less than four hours 26 (52%) patients were admitted. and 7 (14%) patients died. Conclusion:-In liver impairment rodenticide poisoning patients, early use of NAC shows a significant result and the rate of recovery is also high.

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“…being reported as a cause of ALF. 3 The ingestion is commonly suicidal and predominantly reported in individuals between the 2nd and 4th decades of life, although accidental ingestion by children has also been reported. Over the last 5 years, it has become a common indication for emergency liver transplantation (LT) in South India.…”

mentioning

confidence: 99%

“…Mortality has ranged from 20% to 30% in various reports, with ALF being the most common cause of death. 3,5 This epidemic of YP poisoning due to rodenticide ingestion is a relatively new phenomenon, and there are no clear guidelines with regard to its management. Most patients are initially treated in smaller peripheral hospitals, not all of which will have the facilities for monitoring or organ support to manage such sick patients.…”

mentioning

confidence: 99%

Liver Transplantation Society of India Guidelines for the Management of Acute Liver Injury Secondary to Yellow Phosphorus–Containing Rodenticide Poisoning Using the Modified Delphi Technique of Consensus Development

Reddy¹,

Rajakumar²,

Mathew

et al. 2021

Journal of Clinical and Experimental Hepatology

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Background: Acute liver failure caused by the ingestion of yellow phosphorus-containing rodenticide has been increasing in incidence over the last decade and is a common indication for emergency liver transplantation in Southern and Western India and other countries. Clear guidelines for its management are necessary, given its unpredictable course, potential for rapid deterioration and variation in clinical practice. Methods: A modified Delphi approach was used for developing consensus guidelines under the aegis of the Liver Transplantation Society of India. A detailed review of the published literature was performed. Recommendations for three areas of clinical practice, assessment and initial management, intensive care unit (ICU) management and liver transplantation, were developed. Results: The expert panel consisted of 16 clinicians, 3 nonclinical specialists and 5 senior advisory members from 11 centres. Thirty-one recommendations with regard to criteria for hospital admission and discharge, role of medical therapies, ICU management, evidence for extracorporeal therapies such as renal replacement therapy and therapeutic plasma exchange, early predictors of need for liver transplantation and perioperative care were developed based on published evidence and combined clinical experience. Conclusion: Development of these guidelines should help standardise care for patients with yellow phosphorus poisoning and identify areas for collaborative research.

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Rat Killer Poisoning vs Liver Damage: A View in South Indian Patients of Tertiary Care Center

Cited by 6 publications

References 0 publications

Acute Liver Failure Secondary to Yellow Phosphorus Rodenticide Poisoning: Outcomes at a Center With Dedicated Liver Intensive Care and Transplant Unit

Acute Liver Failure Secondary to Yellow Phosphorus Rodenticide Poisoning: Outcomes at a Center With Dedicated Liver Intensive Care and Transplant Unit

Role and effects of n-acetylcysteine in rat killer (rodenticide) poisoning

Liver Transplantation Society of India Guidelines for the Management of Acute Liver Injury Secondary to Yellow Phosphorus–Containing Rodenticide Poisoning Using the Modified Delphi Technique of Consensus Development

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