Plasmapheresis in lethal yellow phosphorus poisoning: a scope for recovery

A 16-year-old girl presented with grade 3 hepatic encephalopathy (HE) following suicide attempt after consuming a lethal dose of yellow phosphorus containing rodenticide. Although she was a candidate for liver transplantation, it could not be done. In the absence of a specific antidote for yellow phosphorus poisoning, the patient was managed conservatively. In addition, low volume-therapeutic plasma exchange (LV-TPE) was initiated, which resulted in a dramatic improvement in HE. Although liver transplantation is the definitive treatment, this case has shown that TPE has a promising role as a ‘bridge to recovery’ in situations where transplantation is not feasible. We describe our experience with the above-mentioned case, along with the sequence of clinical recovery and the trend in biochemical parameters during follow-up. The patient made a full recovery and is doing well.

Survival benefits of N- Acetylcysteine in rodenticide poisoning: Retrospective Evidence from an Indian tertiary care setting

Rationale & Objective: Rodenticide poisoning, either accidental or intentional, is very common in rural India. Absence of a definite antidote made it a major concern with a high mortality rate. So, we aimed to assess the effectiveness of N-Acetyl Cysteine (NAC) in rodenticide poisoning as there are recent positive shreds of evidence on it. Methodology: A retrospective study was conducted in an tertiary care teaching hospital on patients admitted with rodenticide poisoning during a period of 2012- 2017. The Fischer’s exact test and relative risk were measured to analyse the outcome of treatment and risk factors, respectively. Results: A total of 229 patients were enrolled in the study with a mean age of 30.04 ± 15.67 years. The suicidal attack was the major (86.0%) reason for poison consumption. The survival rate was significantly (p ≤ 0.03) higher in the NAC treatment group compared to the non-NAC group. Moreover, the majority (93.4%) of participants didn’t experience any adverse effects. The mean oral loading dose and maintenance dose was 7580.95 ± 2204.29 mg and 3694.53 ± 2322.58 mg, respectively. Yellow Phosphorus poisoning (Relative Risk [RR] 2.888 ((1.179-7.079); p=0.020) and Time lag ≥ 24 hours (RR 3.479 (1.137-10.645); p=0.029) were the significant risk factors for mortality. Conclusion: NAC is shown to have a significant survival benefit with good safety profile among the rodenticide poisoners. Further, adequately powered prospective researches with more emphasis on dosing parameters are warranted for better quantification in different settings and for clinical implementation.