Management of Yellow Phosphorus Poisoning
Immediate Decontamination and Safety Measures
Healthcare providers must wear proper personal protective equipment (PPE) when caring for patients with yellow phosphorus exposure to prevent secondary contamination. 1
- Remove all contaminated clothing immediately and perform copious irrigation with soap and water for external exposure. 1
- Call emergency medical services immediately for patients with systemic symptoms or large chemical exposures. 1
- Yellow phosphorus is a potent hepatotoxin causing damage to gastrointestinal, hepatic, cardiovascular, and renal systems with no specific antidote available. 2, 3
Supportive Care: The Cornerstone of Management
Management of yellow phosphorus poisoning is entirely supportive, as no antidote exists. 2, 3
Airway and Breathing Management
- Secure airway, breathing, and circulation as the foundation of treatment. 4
- Consider early endotracheal intubation for patients with altered mental status or respiratory compromise. 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. 1
- Correct critical vital sign and metabolic derangements promptly. 4
Monitoring and Complications
Hepatotoxicity Monitoring
- Yellow phosphorus classically manifests with acute hepatitis progressing to acute liver failure, which may require liver transplantation. 5
- Monitor for coagulopathy, which is a poor prognostic indicator and develops in all severe cases. 1, 3
- Features of acute liver failure including coagulopathy were seen in all patients in case series. 3
Multi-Organ Dysfunction
- Monitor for hepatic encephalopathy and multi-organ dysfunction syndrome. 6
- Watch for gastrointestinal complications including duodenal perforation and contained perforations. 2
- Monitor renal function for acute kidney injury development. 7
Clinical Course Awareness
- Patients may present with an initial symptomatic phase (nausea, vomiting, abdominal pain), followed by a deceptive symptom-free interval on day 2, then severe deterioration with generalized weakness, drowsiness, and breathing difficulties. 6
- Mean duration of presentation after consumption is typically five days. 3
Advanced Interventions for Severe Cases
Plasmapheresis/Therapeutic Plasma Exchange
- Plasmapheresis appears beneficial by removing the toxin, its metabolites, or inflammatory mediators released in response to the toxin. 7
- Case reports demonstrate complete reversal of acute liver failure with acute kidney injury when plasmapheresis is performed with timely intervention. 7
Liver Transplantation
- The only definitive management for yellow phosphorus-induced acute liver failure is liver transplantation. 7
- Early referral to a tertiary care center with transplant capabilities is critical. 3
Consultation and Poison Center Support
Contact regional poison centers immediately for expert treatment guidance, as board-certified medical and clinical toxicologists can provide specialized support. 4
- In the United States, call 1-800-222-1222 to reach any poison center. 4
- Timely consultation with a medical toxicologist or clinical toxicologist facilitates rapid and effective therapy. 4
Critical Pitfalls to Avoid
- Never delay supportive care while searching for a specific antidote—none exists for yellow phosphorus poisoning. 2, 3
- Do not be falsely reassured by the symptom-free interval on day 2; severe deterioration typically follows. 6
- Avoid discharge against medical advice during the early phase, as delayed severe complications are the rule rather than the exception. 6
- Despite all patients receiving supportive therapy in case series, poor outcomes or death resulted in the majority, emphasizing the importance of early aggressive intervention and tertiary care referral. 3