Advertisement

Indian Journal of Gastroenterology

, Volume 34, Issue 4, pp 325–329 | Cite as

Acute liver failure due to zinc phosphide containing rodenticide poisoning: Clinical features and prognostic indicators of need for liver transplantation

  • Vivek Saraf
  • Supriya Pande
  • Unnikrishnan Gopalakrishnan
  • Dinesh Balakrishnan
  • Ramachandran N. Menon
  • O. V. Sudheer
  • Puneet Dhar
  • S. SudhindranEmail author
Short Report

Abstract

Zinc phosphide (ZnP) containing rodenticide poisoning is a recognized cause of acute liver failure (ALF) in India. When standard conservative measures fail, the sole option is liver transplantation. Records of 41 patients admitted to a single centre with ZnP-induced ALF were reviewed to identify prognostic indicators for requirement of liver transplantation. Patients were analyzed in two groups: group I (n = 22) consisted of patients who either underwent a liver transplant (n = 14) or died without a transplant (n = 8); group II (n = 19) comprised those who survived without liver transplantation. International normalized ratio (INR) in group I was 9 compared to 3 in group II (p < 0.001). Encephalopathy occurred only in group I. Model for End-Stage Liver Disease (MELD) score in group I was 41 compared to 24 in group II (p < 0.001). MELD score of 36 (sensitivity of 86.7 %, specificity of 90 %) or a combination of INR of 6 and encephalopathy (sensitivity of 100 %, specificity of 83 %) were the best indicators of mortality. Such patients should undergo urgent liver transplantation.

Keywords

Acute liver failure King’s College criteria Zinc phosphide 

Notes

Conflict of interest

VS, SP, UG, DB, RNM, OVS, PD, and SS declare that they have no competing interests.

Ethics statement

The authors hereby declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and that the authors followed the policy concerning informed consent as shown on Springer.com.

References

  1. 1.
    Chugh SN, Aggarwal HK, Mahajan SK. Zinc phosphide intoxication symptoms: analysis of 20 cases. Int J Clin Pharmacol Ther. 1998;36:406–7.PubMedGoogle Scholar
  2. 2.
    Sangle SA, Thomas A, Verma S, Wadia RS. Zinc phosphide poisoning. J Assoc Physicians India. 1987;35:591–4.PubMedGoogle Scholar
  3. 3.
    Karanth S, Nayyar V. Rodenticide-induced hepatotoxicity. J Assoc Physicians India. 2003;51:816–7.PubMedGoogle Scholar
  4. 4.
    Jalali N, Shadnia S, Abdofiahi M, Pajoumand A. Survival following severe aluminium phosphide poisoning. J Pharm Pract Res. 2002;32:297.Google Scholar
  5. 5.
    Aniket AS, Anurag SL, Harsha RS, Ganesh BP, Shashank ST. A Case on suicidal poisoning associated with Ratol and a perspective on yellow phosphorus poisoning. Int J Recent Trends Sci Technol. 2014;10:223–5.Google Scholar
  6. 6.
    Akkaoui M, Achour S, Abidi K, et al. Reversible myocardial injury associated with aluminium phosphide poisoning. Clin Toxicol. 2007;45:728–31.CrossRefGoogle Scholar
  7. 7.
    Santos O, Restrepo JC, Velásquez L, et al. Acute liver failure due to white phosphorus ingestion. Ann Hepatol. 2009;8:162–5.PubMedGoogle Scholar
  8. 8.
    O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–45.PubMedGoogle Scholar
  9. 9.
    Acharya SK, Dasarathy S, Kumer TL, et al. Fulminant hepatitis in a tropical population: clinical course, cause, and early predictors of outcome. Hepatology. 1996;23:1448–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–21.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2015

Authors and Affiliations

  • Vivek Saraf
    • 1
  • Supriya Pande
    • 2
  • Unnikrishnan Gopalakrishnan
    • 1
  • Dinesh Balakrishnan
    • 1
  • Ramachandran N. Menon
    • 1
  • O. V. Sudheer
    • 1
  • Puneet Dhar
    • 1
  • S. Sudhindran
    • 1
    Email author
  1. 1.Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research CentreKochiIndia
  2. 2.Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

Personalised recommendations