Indian Journal of Critical Care Case Report

Register      Login

VOLUME 2 , ISSUE 1 ( January-February, 2023 ) > List of Articles


Acute Fulminant Liver Failure Secondary to Yellow Phosphorus Poisoning: Role of Extended N-acetylcysteine Therapy

Shivakumar Shivanna, Pavitra Pushpa, Indira Menon, Deepa Das, Swapna M Babu, Deepak I Tauro

Keywords : Drug-induced, Fatal toxicity, Intensive care unit

Citation Information : Shivanna S, Pushpa P, Menon I, Das D, Babu SM, Tauro DI. Acute Fulminant Liver Failure Secondary to Yellow Phosphorus Poisoning: Role of Extended N-acetylcysteine Therapy. 2023; 2 (1):11-13.

DOI: 10.5005/jp-journals-11006-0033

License: CC BY-NC 4.0

Published Online: 07-03-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Yellow phosphorus is widely used in agricultural applications as well as a rodenticide. Poisoning from unintentional consumption and suicidal intent is common in the Indian subcontinent. Acute fulminant liver failure caused by yellow phosphorus intoxication is fatal. Treatment options include early intervention with supportive care, N-acetylcysteine (NAC), plasmapheresis, and liver transplantation. We used an extended NAC therapy, which resulted in a favorable outcome for our patient.

  1. Nalabothu M, Monigari N, Acharya R. Clinical profile and outcomes of rodenticide poisoning in tertiary care hospital. IJSRP 2015;5(1):8–12.
  2. McCarron MM, Gaddis GP, Trotter AT. Acute yellow phosphorus poisoning from pesticide pastes. Clin Toxicol 1981;18(6):693–711. DOI: 10.3109/15563658108990295
  3. Parkash O, Mumtaz K, Hamid S, et al. MELD score: utility and comparison with King's College criteria in non-acetaminophen acute liver failure. J Coll Physicians Surg Pak 2012;22(8):492–496.
  4. Lee WM, Hynan LS, Rossaro L, et al. Acute liver failure study group: 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
  5. Kortsalioudaki C, Taylor RM, Cheeseman P, et al. Safety and efficacy of N-acetylcysteine in children with non-acetaminophen-induced acute liver failure. Liver Transpl 2008;14(1):25–30. DOI: 10.1002/lt.21246
  6. Darweesh SK, Ibrahim MF, El-Tahawy MA. Effect of N-acetylcysteine on mortality and liver transplantation rate in non-acetaminophen-induced acute liver failure: a multicenter study. Clin Drug Investig 2017;37(5):473–482. DOI: 10.1007/s40261-017-0505-4
  7. Singh S, Hynan LS, Lee WM, et al. Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous n-acetylcysteine in early stage non-acetaminophen acute liver failure. Dig Dis Sci 2013;58(5):1397–1402. DOI: 10.1007/s10620-012-2512-x
  8. Harrison PM, Wendon JA, Gimson AE, et al. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med 1991;324(26):1852–1857. DOI: 10.1056/NEJM199106273242604
  9. Mohanka R, Rao P, Shah M, et al. Acute liver failure secondary to yellow phosphorus rodenticide poisoning: outcomes at a center with dedicated liver intensive care and transplant unit. J Clin Exp Hepatol 2020;11(4):424–434. DOI: 10.1016/j.jceh.2020.09.010
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.