Role of therapeutic plasma exchange in acute liver failure due to yellow phosphorus poisoning

Varghese, Joy; Joshi, Veena; Bollipalli, Madhan Kumar; Malleeswaran, Selvakumar; Patcha, Rajinikanth; Nair, Harikumar; Vij, Vivek; Sachan, Deepti; Pushkala, Subramanian; Jain, Mayank; Venkataraman, Jayanthi

doi:10.1007/s12664-020-01095-y

Cited by 23 publications

(17 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients usually get admitted during the third stage in a critically ill condition and need urgent ICU care, organ support and liver support therapies. There is increasing evidence for the role of therapeutic plasma exchange as a treatment option for ALF secondary to YPR poisoning and studies suggest that when initiated early enough, the need for emergency liver transplant may be reduced [ 5 ]. In severe cases, deterioration of liver function with the onset of encephalopathy and death occurs rapidly.…”

Section: Discussionmentioning

confidence: 99%

Novel radiological technique to recognize acute liver failure caused by yellow phosphorous containing rodenticides

Gopal

Krishnan

Malleswaran

et al. 2023

Indian J Gastroenterol

Self Cite

View full text Add to dashboard Cite

Yellow phosphorous rodenticide (YPR) poisoning is the commonest cause for acute liver failure (ALF) in southern and western India. Due to medicolegal issues, history of YPR ingestion may not be available. As early recognition of YPR poisoning is important and there are no specific biochemical assays, other early predictors to identify this entity is necessary. We evaluated the diagnostic role of plain computed tomography (CT) in identifying YPR-induced ALF. All patients admitted to the liver unit with a diagnosis of ALF underwent a plain CT scan abdomen. Demographic details, clinical history, laboratory parameters, liver attenuation index (LAI) calculated on CT scan, treatment details, need for liver transplantation and clinical outcome were analyzed. Parameters for YPR-induced ALF (ALF-YPR) and other causes (ALF-OTH) were compared. Ability of LAI to distinguish ALF-YPR and ALF-OTH was analyzed using receiver operating characteristic (ROC) curve analysis. Twenty-four patients (15 female [62.5%]) were included in the study. Thirteen patients (54%) had YPR poisoning, while the rest formed the ALF-OTH group (11,46%). ALF-YPR patients had higher transaminase levels, lower peak serum bilirubin levels. ALF-YPR livers had significantly lower LAI as compared to ALF-OTH (− 30 vs. − 8, p = 0.001). On ROC curve analysis, an LAI greater than − 18 ruled out YPR as the cause for ALF with 91% sensitivity and 85% specificity. On regression analysis, LAI was the only independent factor predicting ALF-YPR (odds ratio − 0.86, [0.76, 0.96] p = 0.008). Our data shows that LAI on plain abdominal CT scan can be used to quickly recognize ALF-YPR in unclear cases so that necessary treatment protocol can be activated, or patient transfer arranged. Our analysis shows that an LAI greater than − 18 can reliably rule out YPR ingestion as the cause for ALF.

show abstract

Section: Discussionmentioning

confidence: 99%

Novel radiological technique to recognize acute liver failure caused by yellow phosphorous containing rodenticides

Gopal

Krishnan

Malleswaran

et al. 2023

Indian J Gastroenterol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Fulminant hepatic failure in yellow phosphorus poisoning is common in developing countries although suicidal ingestion is not rare. ALF, acute tubular necrosis, cardiac arrhythmias, convulsions, coma, and circulatory collapse are the possible consequences of intoxication which may be fatal [3,4].…”

Section: Ravikanti Et Almentioning

confidence: 99%

Liver transplantation for fulminant hepatic failure in yellow phosphorus poisoning

Ravikanti¹,

Yadav²,

Rangappa³

et al. 2022

Indian J Case Reports

View full text Add to dashboard Cite

Yellow phosphorus (YP) containing rodenticides is a readily available poison that may be accidentally or deliberately ingested, leading to symptoms ranging from simple gastrointestinal symptoms to fulminant hepatic failure, depending on the amount ingested. As there is no specific antidote, the treatment requires early gastric lavage and institution of supportive measures such as acetyl cysteine infusion and Vitamin K. Progression to fulminant hepatic failure is characterized by rapid deterioration of liver function tests, worsening coagulopathy, and sensorium. The only definitive treatment at this stage is a liver transplant and therapeutic plasma exchange (TPE) can serve as a bridge therapy until a compatible liver donor is found. We present a case of YP-containing rodenticide poisoning, in which the patient progressed to fulminant hepatic failure despite aggressive supportive therapy and was successfully managed with TPE until liver transplantation.

show abstract

“…Yellow phosphorus is a protoplasmic toxin that can cause hepatocellular necrosis and hepatic failure, the only definitive treatment for it is liver transplantation (LT). Varghese and colleagues from the Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai, India report their experience of using therapeutic plasma exchange (TPE) in 43 patients with acute liver failure (ALF) due to yellow phosphorus poisoning (YPP), 23 of whom did not meet LT criteria (group B) [3]. Although transaminases improved in both the groups, significant improvement in serum ammonia and 100% survival was noted in group B.…”

Section: Role Of Therapeutic Plasma Exchange In Acute Liver Failure Dmentioning

confidence: 99%

Editorial commentary on the Indian Journal of Gastroenterology November-December 2020

Limdi

2020

Indian J Gastroenterol

View full text Add to dashboard Cite

Role of therapeutic plasma exchange in acute liver failure due to yellow phosphorus poisoning

Cited by 23 publications

References 15 publications

Novel radiological technique to recognize acute liver failure caused by yellow phosphorous containing rodenticides

Novel radiological technique to recognize acute liver failure caused by yellow phosphorous containing rodenticides

Liver transplantation for fulminant hepatic failure in yellow phosphorus poisoning

Editorial commentary on the Indian Journal of Gastroenterology November-December 2020

Contact Info

Product

Resources

About