What is the treatment for yellow phosphorus poisoning?

Treatment for Yellow Phosphorus (Ratol) Poisoning

The management of yellow phosphorus poisoning is primarily supportive care as there is no specific antidote available, with early gastric decontamination, aggressive fluid resuscitation, and monitoring for multi-organ failure, particularly hepatic dysfunction. 1, 2

Initial Management

• Ensure proper personal protective equipment (PPE) when caring for patients with yellow phosphorus exposure to prevent contamination of caregivers 3
• Immediate decontamination through removal of contaminated clothing and copious irrigation with soap and water for external exposure 3
• For recent ingestions (within 1-2 hours), consider gastric lavage with potassium permanganate (1:5000) solution to oxidize phosphorus to less toxic phosphoric acid 4
• Activated charcoal administration may help reduce absorption of the toxin 4
• Call emergency medical services immediately for patients with systemic symptoms or large chemical exposures 5

Monitoring and Supportive Care

• Monitor liver function tests closely as yellow phosphorus is a potent hepatotoxin causing fulminant hepatic failure 1, 2
• Observe for the classic triphasic clinical presentation:
  • Phase 1 (0-24 hours): Gastrointestinal symptoms (nausea, vomiting, diarrhea) 2, 6
  • Phase 2 (24-72 hours): Apparent recovery with stable vitals (deceptive improvement) 2
  • Phase 3 (72-96 hours): Multi-organ failure, particularly hepatic failure with encephalopathy 2, 4
• Maintain fluid and electrolyte balance with aggressive intravenous hydration 4
• Monitor renal function as acute kidney injury commonly accompanies hepatic failure 2, 6

Management of Specific Complications

• For hepatic failure:

  • Consider N-acetylcysteine administration (though evidence is limited for phosphorus poisoning) 4
  • Therapeutic plasma exchange (plasmapheresis) may help remove toxins and inflammatory mediators 4
  • Early consultation for possible liver transplantation, which is the only definitive management for severe cases 6, 4

• For seizures associated with toxicity:

  • Administer benzodiazepines as first-line treatment 3

• For metabolic acidosis:

  • Consider sodium bicarbonate administration for severe acidosis 7

Prognosis and Follow-up

• Mortality is high in yellow phosphorus poisoning, particularly with ingestions exceeding 1 mg/kg 8

• Poor prognostic indicators include:

  • Jaundice
  • Coagulopathy
  • Encephalopathy
  • Elevated liver enzymes (AST, ALT >1000 IU/L)
  • Metabolic acidosis 2, 4

• Long-term follow-up of liver function is necessary for survivors 4

Special Considerations

• Yellow phosphorus poisoning is often misdiagnosed initially due to non-specific symptoms 6
• The deceptive "silent phase" after initial symptoms may lead to premature discharge; patients should be observed for at least 72 hours 2
• Liver transplantation should be considered early in patients showing signs of fulminant hepatic failure 6, 4