Treatment for Yellow Phosphorus Poisoning
Yellow phosphorus poisoning requires immediate supportive care with decontamination, aggressive management of hepatotoxicity, and consideration for emergency liver transplantation in cases of fulminant hepatic failure, as no specific antidote exists. 1, 2
Immediate Decontamination and Safety Measures
- Remove all contaminated clothing immediately and perform copious irrigation with soap and water to prevent continued absorption and secondary contamination 1
- Healthcare providers must wear appropriate personal protective equipment (PPE) to avoid exposure during patient care 1
- Contact poison control center (1-800-222-1222 in the US) for expert toxicology guidance 3
Supportive Care and Monitoring
Airway and Hemodynamic Management
- Prioritize airway management, hemodynamic support, and correction of critical vital sign abnormalities before specific toxin identification 3
- Administer 100% oxygen to maintain tissue oxygenation 3
- Provide aggressive fluid resuscitation and vasopressor support if cardiovascular collapse develops 4
Seizure Management
- Administer benzodiazepines as first-line treatment for seizures associated with yellow phosphorus toxicity 1
Metabolic Derangements
- Consider sodium bicarbonate administration for severe metabolic acidosis that commonly develops in severe poisoning 1
Hepatotoxicity Management
Yellow phosphorus is a potent hepatotoxin causing acute liver failure through direct cellular damage 2, 5. The clinical course typically manifests as:
- Initial gastrointestinal symptoms (nausea, vomiting, diarrhea) followed by apparent improvement 5
- Acute hepatitis progressing to fulminant hepatic failure with markedly elevated transaminases (AST/ALT often >1000 IU/L) 4
- Coagulopathy (INR often >6) indicating poor prognosis 1, 4
- Hepatic encephalopathy (grade II-III) signaling irreversible liver damage 4
Liver Transplantation Considerations
Emergency living donor liver transplantation (LDLT) should be considered when signs of irreversible acute liver failure are detected, as this represents the only lifesaving intervention 4. Key indicators for transplant evaluation include:
- Grade II or III hepatic encephalopathy 4
- INR >6 with progressive coagulopathy 4
- Pediatric End-Stage Liver Disease (PELD) score >30 4
- Rising bilirubin despite supportive care 4
Critical caveat: Even with successful liver transplantation, mortality remains very high (50% in one pediatric series) when yellow phosphorus toxicity affects multiple organ systems, particularly the brain and heart 4. Three of six transplanted patients died within three days postoperatively despite well-functioning grafts 4.
Additional Organ System Complications
Renal Toxicity
- Monitor for acute kidney injury and hepatorenal syndrome, which frequently accompany hepatic failure 2, 5
- Autopsy findings show disseminated degeneration in proximal renal tubules 5
Gastrointestinal Complications
- Monitor for gastrointestinal perforation, particularly duodenal perforation with contained leaks 2
- Watch for parenchymal hemorrhages in the liver 2
Cardiovascular Collapse
- Cardiovascular collapse is a terminal event often occurring alongside hepatorenal failure 5, 4
- When concomitant hepatorenal failure and cardiovascular collapse develop, death is typically inevitable 5
Prognosis
Yellow phosphorus poisoning carries an extremely high mortality rate even with aggressive supportive care 5, 4. Poor prognostic indicators include:
- Development of coagulopathy 1
- Multi-organ involvement (liver, kidney, heart, brain) 4
- Cardiovascular collapse 5, 4
- Persistent encephalopathy post-transplant 4
The safest method of managing yellow phosphorus poisoning is prevention, as therapeutic options remain limited once systemic toxicity develops 6.