2009, Number 2
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Ann Hepatol 2009; 8 (2)
Acute liver failure due to white phosphorus ingestion
Santos O, Restrepo Juan-Carlos, Velásquez L, Castaño J, Correa G, Sepúlveda E, Yepes N, Hoyos S, Guzmán C, Osorio G, Cárdenas A
Language: English
References: 16
Page: 162-165
PDF size: 67.42 Kb.
Text Extraction
Background: White phosphorus is chemical compound available in military ammunition as well as in explosive powder of recreational use. This latter form is commonly found in Latin America and Asia as a main ingredient of gunpowder used to make street firecrackers. Small firecrackers may be ingested accidentally or used as a toxic agent in suicidal attempts which may cause of acute liver failure and death; however the clinical features, incidence and outcome are poorly described in the literature.
Methods: We describe three cases of white phosphorus intoxication with acute liver failure secondary to the consumption of firecrackers. In two cases, ingestion occurred secondary to suicidal attempts and in one, ingestion occurred by accident. In one case, liver injury improved with supportive care, in the other, the patient required liver transplantation and the third case had a fatal outcome.
Conclusions: Clinicians providing care of patients with acute hepatitis of unclear etiology should be aware that the ingestion of firecrackers containing white phosphorus might cause acute liver failure that may require liver transplantation.
REFERENCES
Konjoyan TR: White phosphorus burns: Case report and literature review. Milit Med 1983; 148: 881-884.
Mozingo DW, Smith AA, McManus WF, et al. Chemical burns. J Trauma Inj Crit Care 1988; 28: 642-647.
Noguera A, Cato-David A. Intoxicaciones agudas por fósforo blanco. Rev Med y Cirugia 1966; 1: 209-18.
Brent J, Wallace K, Buckhart K. Phosphorus. In: Brent J, Wallace K, Buckhart K, eds. Critical care toxicology: diagnosis and management of the critically poisoned patient. Elsevier Saunders 2005: 851-861.
Diaz-Rivera RS, Collazo PJ, Pons ER, Torregosa MV. Acute phosphorus poisoning in man: A study of 56 cases. Medicine 1950; 29: 269-298.
McCarron MM, Gaddis GP, Trotter AT. Acute yellow phosphorus poisoning from pesticide pastes. Clin Toxicol 1981; 18: 693-711.
Agency for Toxic Substances and Disease Registry (ATSDR). US Department of Health and Human Services, Public Health Service. Toxicological profile for white phosphorus. 1997. http://www.atsdr.cdc.gov/tfacts103.html (accessed September 12, 2008).
Fernandez OU, Canizares LL. Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks. J Clin Gastroenterol 1995; 21: 139-142.
Cameron JM, Patrick RS. Acute phosphorus poisoning-the distribution of toxic doses of yellow phosphorus in the tissues of experimental animals. Med Sci Law 1966; 6: 209-214.
Winek CL, Collom WD, Fusia EP. Yellow phosphorus ingestion-three fatal poisonings. Clin Toxicol 1973; 6: 541-545.
Seakins A, Robinson DS. Changes associated with the production of fatty livers by white phosphorus and by ethanol in the rat. Biochem J 1964; 92: 308-312.
Ghoshal AK, Porta EA, Hartroft WS. The role of lipoperoxidation in the pathogenesis of fatty livers induced by phosphorus poisoning in rats. Am J Pathol 1969; 54: 275-291.
Chretien TE. Acute phosphorus poisoning: Report of a case with recovery. N Engl J Med 1945; 223: 247-29.
Talley RC, Linhart JW, Trevino AJ. Acute elemental phosphorus poisoning in man: cardiovascular toxicity. Am Heart J 1972; 84: 139-140.
Polson J, Lee WM. AASLD Position paper: The management of acute liver failure. Hepatology 2005; 41: 1179-1197.
Marin GA, Montoya CA, Sierra JL, Senior JR. Evaluation of corticosteroid and exchange-transfusion treatment of acute yellow-phosphorus intoxication. N Engl J Med 1971; 284: 125-128.