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

Abstract

Yellow phosphorus (YP) is a powerful protoplasmic poison used in the manufacturing of matches, pest poisons, firecrackers, firework cracker, lights for watches, military ammunition, and agriculture fertilizer. YP is extremely flammable and toxic and easily absorbed from the gastrointestinal tract. In this study, we examined childhood deaths from 1997 to 2012 resulting from the ingestion of firecrackers. The patients ranged from 2 to 15 years of age and were admitted to the hospital with a variety of symptoms. Those that presented with nausea, vomiting, and hypotension rapidly deteriorated and entered a coma. An autopsy was performed in all but one of the 16 cases reviewed. Macroscopically, the livers had a yellowish discoloration with petechial bleeding. Histopathologic examination revealed acute toxic hepatitis. In conclusion, these firecrackers are found in corner shops throughout Turkey, may cause death in children with little warning, and should be banned to prevent further deaths.

Histopathological Profile In Fatal Yellow Phosphorous Poisoning

“…Macroscopic examination of the liver has revealed yellowish discoloration and petechial bleeding on the liver surface (6,7). The lungs were found to be heavy due to pulmonary edema but no macroscopic abnormalities were detected in the heart, kidney, and spleen (7). The most common autopsy feature noticed in our study was congestion followed by petechial hemorrhage of the studied viscera.…”

“…However, macrovesicular steatosis was not an early feature since all cases except one were noticed after 3 days. The earliest change we noticed was hepatic necrosis and sinusoidal congestion in a patient who survived for 8 h. One study from Turkey observed sinusoidal congestion, diffuse microvesicular steatosis, and increased round cells in the portal region of patients who died immediately whereas patients who survived longer showed massive periportal necrosis, acute inflammatory cells, macrophages, bile duct proliferation, pseudo glandular proliferation, and widespread cholestasis (7). Apart from ductal proliferation, features of cholestasis and steatosis were observed in the person who survived for the longest duration in our study.…”

“…Macroscopic examination of the liver has revealed yellowish discoloration and petechial bleeding on the liver surface . The lungs were found to be heavy due to pulmonary edema but no macroscopic abnormalities were detected in the heart, kidney, and spleen .…”

“…Early literature reports two case series that originated from Puerto Rico and Venezuela . The recent literatures on YP are reported from Ecuador and Turkey due to firecracker ingestion and India due to rodenticide paste ingestion . The study on histopathological appearance of viscera in YP poisoning is very limited with one autopsy study from Venezuela .…”

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

“…Over the last 5 years, it has become a common indication for emergency liver transplantation (LT) in South India. Reports of YP poisoning through its use in fireworks have also been reported from several other countries [4][5][6] (Figure 1).…”