PDF(Sci-hub)
Abstract：
Accidental or suicidal poisoning with yellow phosphorus or metal phosphides (YPMP) such as aluminum (AlP) zinc phosphide (Zn3P2) commonly cause acute liver failure (ALF) and cardiotoxicity. These are used as household, agricultural and industrial rodenticides and in production of ammunitions, firecrackers and fertilizers. In absence of a clinically available laboratory test for diagnosis or toxin measurement or an antidote, managing their poisoning is challenging even at a tertiary care center with a dedicated liver intensive care unit (LICU) and liver transplant facility.
METHODS: Patients with YPMP related ALF were monitored using standardized clinical, hemodynamic, biochemical, metabolic, neurological, electrocardiography (ECG) and SOFA score and managed using uniform intensive care, treatment and transplant protocols in LICU. Socio-demographic characteristics, clinical and biochemical parameters and scores were summarized and compared between 3 groups i.e. spontaneous survivors, transplanted patients and non-survivors. Predictors of spontaneous survival and the need for liver transplant are also evaluated.
RESULTS: Nineteen patients with YPMP related ALF were about 32 years old (63.2% females) and presented to us at a median of 3 (0 - 10) days after poisoning. YPMP related cardiotoxicity was rapidly progressive and fatal whereas liver transplant was therapeutic for ALF. Spontaneous survivors had lower dose ingestion (<17.5 grams), absence of cardiotoxicity, < grade 3 HE, lactate < 5.8, SOFA score < 14.5, and increase in SOFA score by < 5.5. Patients with renal failure need for CVVHDF and KCC positivity on account of PT-INR > 6.5 had higher mortality risk. Patients undergoing liver transplant and with spontaneous recovery required longer ICU and hospital stay. At median follow-up of 3.4 (2.6 - 5.5) years, all spontaneous survivors and transplanted patients are well with normal liver function.
CONCLUSIONS: Early transfer to a specialized center, pre-emptive close monitoring, and intensive care and organ support with ventilation, CVVHDF, plasmapheresis and others may maximize their chances of spontaneous recovery, allow accurate prognostication and a timely liver transplant.
METHODS: Patients with YPMP related ALF were monitored using standardized clinical, hemodynamic, biochemical, metabolic, neurological, electrocardiography (ECG) and SOFA score and managed using uniform intensive care, treatment and transplant protocols in LICU. Socio-demographic characteristics, clinical and biochemical parameters and scores were summarized and compared between 3 groups i.e. spontaneous survivors, transplanted patients and non-survivors. Predictors of spontaneous survival and the need for liver transplant are also evaluated.
RESULTS: Nineteen patients with YPMP related ALF were about 32 years old (63.2% females) and presented to us at a median of 3 (0 - 10) days after poisoning. YPMP related cardiotoxicity was rapidly progressive and fatal whereas liver transplant was therapeutic for ALF. Spontaneous survivors had lower dose ingestion (<17.5 grams), absence of cardiotoxicity, < grade 3 HE, lactate < 5.8, SOFA score < 14.5, and increase in SOFA score by < 5.5. Patients with renal failure need for CVVHDF and KCC positivity on account of PT-INR > 6.5 had higher mortality risk. Patients undergoing liver transplant and with spontaneous recovery required longer ICU and hospital stay. At median follow-up of 3.4 (2.6 - 5.5) years, all spontaneous survivors and transplanted patients are well with normal liver function.
CONCLUSIONS: Early transfer to a specialized center, pre-emptive close monitoring, and intensive care and organ support with ventilation, CVVHDF, plasmapheresis and others may maximize their chances of spontaneous recovery, allow accurate prognostication and a timely liver transplant.
摘要：
黄磷或金属磷化物（YPMP），例如铝（AlP）磷化锌（Zn3P2）的意外或自杀性中毒通常会引起急性肝功能衰竭（ALF）和心脏毒性。这些被用作家庭，农业和工业灭鼠剂以及弹药生产中，鞭炮和肥料。在没有临床可用的诊断或毒素测量实验室测试或解毒剂的情况下，即使在拥有专门的肝脏重症监护病房（LICU）和肝移植设施的三级护理中心，管理他们的中毒也具有挑战性。
方法：使用标准化临床，血液动力学,生物化学，新陈代谢，神经学,心电图（ECG）和SOFA评分，并使用统一的重症监护进行管理，LICU的治疗和移植方案。社会人口特征，临床和生化参数和评分进行总结，并比较3组，即自发幸存者，移植患者和非幸存者。还评估了自发存活和肝移植需求的预测因子。
结果：19例与YPMP相关的ALF患者年龄约为32岁（63.2％为女性），在中毒后的中位数为3（0-10）天。YPMP相关的心脏毒性是快速进展和致命的，而肝移植是ALF的治疗方法。自发性幸存者的剂量较低（<17.5克），没有心脏毒性，<他3级,乳酸<5.8，SOFA评分<14.5，SOFA评分增加<5.5。由于PT-INR>6.5而需要CVVHDF和KCC阳性的肾衰竭患者具有更高的死亡风险。接受肝移植和自发恢复的患者需要更长的ICU和住院时间。在3.4（2.6-5.5）年的中位随访时间，所有自发性幸存者和移植患者的肝功能均正常。
结论：早期转移到专业中心，先发制人的密切监测，重症监护和器官通气支持，CVVHDF,血浆置换和其他人可以最大限度地提高他们的自发恢复的机会，允许准确的预测和及时的肝移植。
方法：使用标准化临床，血液动力学,生物化学，新陈代谢，神经学,心电图（ECG）和SOFA评分，并使用统一的重症监护进行管理，LICU的治疗和移植方案。社会人口特征，临床和生化参数和评分进行总结，并比较3组，即自发幸存者，移植患者和非幸存者。还评估了自发存活和肝移植需求的预测因子。
结果：19例与YPMP相关的ALF患者年龄约为32岁（63.2％为女性），在中毒后的中位数为3（0-10）天。YPMP相关的心脏毒性是快速进展和致命的，而肝移植是ALF的治疗方法。自发性幸存者的剂量较低（<17.5克），没有心脏毒性，<他3级,乳酸<5.8，SOFA评分<14.5，SOFA评分增加<5.5。由于PT-INR>6.5而需要CVVHDF和KCC阳性的肾衰竭患者具有更高的死亡风险。接受肝移植和自发恢复的患者需要更长的ICU和住院时间。在3.4（2.6-5.5）年的中位随访时间，所有自发性幸存者和移植患者的肝功能均正常。
结论：早期转移到专业中心，先发制人的密切监测，重症监护和器官通气支持，CVVHDF,血浆置换和其他人可以最大限度地提高他们的自发恢复的机会，允许准确的预测和及时的肝移植。
