Role of therapeutic plasma exchange in rat killer (yellow phosphorous) poisoning

Abstract

CONTEXT: Yellow phosphorus (YP) 3% is one of the rodenticides available, which is a potent hepatotoxin and it is fatal. Management of YP poisoning is difficult since there is no antidote available; only definitive management is liver transplantation. Therapeutic plasma exchange (TPE) helps the YP poisoning patients by removing the poison or its metabolite or the inflammatory mediators released in the body in response to toxin. AIMS: To determine the role of TPE in rat killer (YP) poisoning. SETTINGS AND DESIGN: This was a descriptive period study conducted from November 2018 to September 2020. SUBJECTS AND METHODS: Sixteen consecutive YP poisoning patients were included in the study (n = 16). A total of 48 sessions of TPE were carried out. Liver function tests such as serum glutamic-oxaloacetic transaminase, SGPT, total bilirubin, and direct bilirubin as well as coagulation profile such as prothrombin time, activated partial thromboplastin time, and international normalized ratio were analyzed at the time of admission, after each TPE session, and at the time of discharge. STATISTICAL ANALYSIS USED: The results were recorded, and it was analyzed statistically by SPSS version 17. RESULTS: Liver function tests improved significantly from the time of admission and after each TPE and at the time of discharge (P < 0.05). Coagulation profile improved statistically (P < 0.05). Thirteen patients were improved in their clinical status, and three patients left the hospital citing personal reasons. CONCLUSIONS: TPE could potentially bridge the gap between medical management and liver transplantation in cases of YP poisoning.

Keywords

• rat killer poisoning
• therapeutic plasma exchange
• yellow phosphorous