Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 5 ( May, 2020 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Rodenticide Poisoning: Critical Appraisal of Patients at a Tertiary Care Center

Shivkumar Gopalakrishnan, Sangeetha Kandasamy, Ramya Iyyadurai

Keywords : Mortality, Rodenticide poisoning, Yellow phosphorus

Citation Information : Gopalakrishnan S, Kandasamy S, Iyyadurai R. Rodenticide Poisoning: Critical Appraisal of Patients at a Tertiary Care Center. Indian J Crit Care Med 2020; 24 (5):295-298.

DOI: 10.5005/jp-journals-10071-23426

License: CC BY-NC 4.0

Published Online: 01-05-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Importance: Rodenticide poisoning is a common occurrence in India. Of the different classes of rodenticides available, yellow phosphorus is considered highly toxic. There are scarce epidemiological data regarding the ingestion of yellow phosphorus in the subcontinent. Objectives: This study aimed to identify the clinical profile of rodenticide-poisoned patients and delineate mortality predictors. Design: Prospective observational study. Setting and participants: Study was conducted at the Department of Internal Medicine, Government Villupuram Medical College and Hospital. All adult inpatients with a history of rodenticide poison exposure were eligible participants. A total of 99 patients completed the study protocol. Main outcome: Survival with or without morbidity and death. Results: In all, 90.91% of patients consumed the paste formulation of rodenticide [yellow phosphorus (67.2%) and yellow phosphorus + zinc phosphide (24%)].The time to resuscitation showed significance to mortality. Survival rate among patients instituted gastric decontamination within 2 hours of exposure (97.87%) was significantly higher than those who were not (84.62%) (p = 0.033). The clinical picture revealed conspicuous absence of signs and symptoms during the first 24 hours. In all, 72.73% (n = 72) manifested with toxidrome after a lag period of 24–36 hours (range 18–72 hours). The dominant clinical manifestations included abdominal pain (52.53%), jaundice (22.21%), coagulopathy (15.15%), encephalopathy (10.10%), shock (10.10%), acute kidney injury (AKI; 7.08%), and multi-organ failure (17.17%). Laboratory data showed elevated aspartate transaminase (AST; 48.47%), alanine aminotransferase (ALT; 49.50%), bilirubin levels (22.21%), metabolic acidosis (10.12%), serum creatinine (7.08%), prothrombin time prolongation (PT/INR; 15.15%), and activated partial thromboplastin time (aPTT) (3.30%). The mortality was 9.1% (n = 9) of which 77.78% (n = 7) died of fulminant hepatic failure. The mean time for death was 4.22 days since exposure (range 2–8 days). Conclusion: Rodenticide poisoning in Southern India is dominated by yellow phosphorus. In this study, we identified delayed resuscitation, jaundice, hepatic encephalopathy, elevation of AST and ALT to >1000 IU/L, metabolic acidosis, and refractory shock as reliable predictors of bad outcome in this patient population. The common mode of death was fulminant hepatic failure. Relevance: Rodenticide poisoning ranks second in mortality hierarchy at our institute, and systematic analysis of this patient population is an urgent need.


PDF Share
  1. Suneetha DK, Inbanathan J, Kannoth S, Reshma PK, Shashank MS. Profile of rat killer poisoning cases in a tertiary care hospital at Mysore. Int J Sci Study 2016;3(12):264–267.
  2. Fernandez OU, Canizares LL. Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks. J Clin Gastroenterol 1995;21(2):139–142. DOI: 10.1097/00004836-199509000-00015.
  3. Nalabothu M, Monigari N, Acharya R. Clinical profile and outcomes of rodenticide poisoning in tertiary care hospital. Int J Sci Res Publ 2015;5(8):1–12. Available from: http://www.ijsrp.org/research-paper-0815/ijsrp-p4442.pdf.
  4. Karanth S, Nayyar V. Rodenticide-induced hepatotoxicity. J Assoc Physicians India 2003;51:816–817.
  5. Fletcher GF, Galambos JT. Phosphorus poisoning in humans. Arch Intern Med 1963;112:846–852. DOI: 10.1001/archinte.1963.03860060084008.
  6. Mishra AK, Devakiruba NS, Jasmine S, Sathyendra S, Zachariah A, Iyadurai R. Clinical spectrum of yellow phosphorous poisoning in a tertiary care centre in South India: A case series. Trop Doct 2016;47(3):245–249. DOI: 10.1177/0049475516668986.
  7. Mauskar A, Mehta K, Nagotkar L, Shanbag P. Acute hepatic failure due to yellow phosphorus ingestion. Indian J Pharmacol 2011;43:355–356. DOI: 10.4103/0253-7613.81500.
  8. Radhika V, Narayanasamy K, Chezhian A, Senthil Kumar R, Jasmine JJ. Rat killer poisoning vs. liver damage: a view in south indian patients of tertiary care center. J Gastroint Dig Syst 2018;8(3):569.
  9. Clinical Practice Guidelines: Paracetamol Poisoning. Available from: http://www.rch.org.au/clinicalguide/guideline_index/paracetamol_poisoning/.
  10. Kharkongore MA, Mishrae AK, Ninane KF, Iyaduraie R. N-Acetylcysteine in yellow phosphorus poisoning. Curr Med Issues 2017;15(2):136–138. DOI: 10.4103/0973-4651.206530.
  11. Lee WM, Hynan LS, Rossaro L, Fontana RJ, Stravitz RT, Larson AM, et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology 2009;137(3):856–864. DOI: 10.1053/j.gastro.2009.06.006,864.e1.
  12. Hu J, Zhang Q, Ren X, Sun Z, Quan Q. Efficacy and safety of acetylcysteine in “non-acetaminophen” acute liver failure: a meta-analysis of prospective clinical trials. Clin Res Hepatol Gastroenterol 2015;39(5):594–599. DOI: 10.1016/j.clinre.2015.01.003.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.