Study on Predictable Factors for Intervention with Heparin Free Plasmapheresis in Impending Liver Cell Failure due to Consumption of Phosphorus Rodenticide: A Clinical Approach | Chapter 19 | Issues and Developments in Medicine and Medical Research Vol. 9

 In adult critical care, poisoning from rodenticides containing yellow phosphorus is prevalent. They cause coagulopathy and liver cell failure in humans [1]. Until far, the only therapeutic option for fulminant liver failure induced by rodenticide overdose has been liver transplantation.

Aims: In this study, patients with liver cell failure who had swallowed yellow phosphorus paste were offered a new treatment method.

Methods: A retrospective examination of case records of liver cell failure cases caused by phosphorus-containing rodenticide poisonings was conducted in a public hospital for a year, from January 2018 to January 2019. Medical case records and postmortem registers were collected from the records department. The following symptoms, signs, investigations, therapies, complications, and outcomes were recorded.

The researchers looked at a total of 11 cases. Eight patients with liver cell failure and coagulopathy who received therapeutic heparin-free plasmapheresis fully recovered from liver cell failure. The introduction of therapy with 5 cycles of heparin free plasmapheresis to eliminate harmful effects of phosphorus on liver cells and in the blood was based on a considerable decline in haemoglobin, platelet count, PT INR Ratio, and rise in serum alkaline phosphatase. With a degree of freedom of 2, a comparison of untreated cases (n=3) vs. plasmapheresis-treated cases (n=8) revealed a significant statistical difference (P 0.005) in outcomes.

Conclusions: Plasmapheresis has the potential to be a therapeutic treatment for liver cell failure induced by yellow phosphorus consumption. Prothrombin time, INR ratio, liver enzymes, and the time gap between intake and the onset of liver cell failure are all predictible markers for imminent liver cell failure in whom plasmapheresis will be beneficial. For all liver cell failures awaiting transplants, the crucial predicted levels for impending coagulopathy and liver cell failure may be further examined.

Author(S) Details

Deepa S. Banjan
Department of Medicine, Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Maharashtra, India.

Kavita Sane
Department of Pathology, Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Maharashtra, India.

Sachchidanand Wattamvar
Department of Physiology, Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Maharashtra, India.

Mahesh More
Department of Medicine, Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Maharashtra, India.

Jyotsna Zope
Nephrology and Kidney Transplantation, Bhakti Vedanta Hospital and Research Centre, Mira Road, India and Nephrology, Chatrapati Shivaji Maharaj Hospital & Rajiv Gandhi Medical College, Thane, India and National Kidney Foundation, India.

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