RESUMEN
Yellow phosphorus is a toxic substance used in the production of firework cracker, fireworks, ammunition and agricultural dung. When ingested, it shows its effects mainly in the liver, the kidneys, and the brain. A four-year-old girl had died as a result of acute hepatic failure caused by ingesting a firework cracker. The case showed high levels of hepatic enzymes, along with non-specific signs such as nausea, vomiting and diarrhea. Autopsy revealed diffuse microvesicular steatosis in the liver and disseminated degeneration in the proximal tubules of the kidneys. In cases with concomitant hepatorenal failure and cardiovascular collapse, death is inevitable. However, when only hepatic failure develops, hepatic transplantation may be lifesaving. Although intoxication from ingesting yellow phosphorus has a very high rate of mortality, forensic cases are extremely rare in the literature.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Sustancias Explosivas/envenenamiento , Compuestos de Fósforo/envenenamiento , Preescolar , Resultado Fatal , Femenino , Humanos , Hígado/patologíaRESUMEN
BACKGROUND: White phosphorus (WP) is widely used illicitly in fireworks in South America. We report our experience in seven Ecuadorian hospitals. METHODS: A cross-sectional study of patients presented during 2009. Inclusion criteria included: reported oral ingestion of firecrackers (little devils) in any age. Data were gathered using inpatient records and a written survey of the victims. RESULTS: The mean age of the patients was 21.6+/-7.1 years (women 63.5%); 64.7% of cases occurred in November, December and January. In 46% of cases, the number of units ingested was between 1 and 5 (~0.3 to 1.5 g WP), maximum 40 (~12 g). Forty-seven cases attended within 12 hours (55.3%); 5.9% died and 2.4% were readmitted. The remainder were eventually discharged well. Clinical features included: abdominal pain, cramps, diarrhoea, jaundice, nausea and vomiting, abnormal liver enzymes, and coagulation times and hypoglycaemia. CONCLUSIONS: The typical case was an adolescent woman between 16 and 19 years with self-harm around Christmas. There was no specific treatment, but early attendance was associated with improved prognosis. Further studies are necessary to establish an adequate protocol of treatment.
Asunto(s)
Sustancias Explosivas/envenenamiento , Compuestos de Fósforo/envenenamiento , Adolescente , Adulto , Niño , Estudios Transversales , Ecuador , Femenino , Humanos , Masculino , Adulto JovenAsunto(s)
Toma de Decisiones/ética , Trasplante de Hígado/ética , Selección de Paciente/ética , Esquizofrenia Paranoide/complicaciones , Adulto , Amisulprida , Antipsicóticos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Contraindicaciones , Humanos , Fallo Hepático Agudo/inducido químicamente , Fallo Hepático Agudo/diagnóstico , Masculino , Compuestos de Fósforo/envenenamiento , Esquizofrenia Paranoide/tratamiento farmacológico , Sulpirida/análogos & derivados , Sulpirida/uso terapéuticoRESUMEN
BACKGROUND: White phosphorus is chemical compound available in military ammunition as well as in explosive powder of recreational use. This latter form is commonly found in Latin America and Asia as a main ingredient of gunpowder used to make street firecrackers. Small firecrackers may be ingested accidentally or used as a toxic agent in suicidal attempts which may cause of acute liver failure and death; however the clinical features, incidence and outcome are poorly described in the literature. METHODS: We describe three cases of white phosphorus intoxication with acute liver failure secondary to the consumption of firecrackers. In two cases, ingestion occurred secondary to suicidal attempts and in one, ingestion occurred by accident. In one case, liver injury improved with supportive care, in the other, the patient required liver transplantation and the third case had a fatal outcome. CONCLUSIONS: Clinicians providing care of patients with acute hepatitis of unclear etiology should be aware that the ingestion of firecrackers containing white phosphorus might cause acute liver failure that may require liver transplantation.
Asunto(s)
Sustancias Explosivas/envenenamiento , Fallo Hepático Agudo/inducido químicamente , Compuestos de Fósforo/envenenamiento , Adolescente , Adulto , Preescolar , Terapia Combinada , Sobredosis de Droga , Resultado Fatal , Femenino , Humanos , Fallo Hepático Agudo/patología , Fallo Hepático Agudo/terapia , Trasplante de Hígado , Masculino , Intento de Suicidio , Resultado del TratamientoRESUMEN
Poisoning by white or yellow phosphorus is reported in various forms and also in ages varying from infants to adults, but spontaneous combustion and explosion during its management has never been described. This incidence occurred while attempting to pass a Ryle's tube. Its free end first exhibited a yellow flame and this later on led to an explosive encounter. Role of static electricity generated while handling plastic materials leading to ignition and explosion cannot be overlooked.