title: Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks.
abstract: We reviewed 15 cases of poisoning from ingestion of yellow phosphorus-containing fireworks and analyzed its associated acute hepatotoxic effects. Two patients (13%) had no clinical or biochemical evidence of hepatic damage, four (27%) had subclinical hepatic injury, five (33%) manifested varying degrees of hepatocellular necrosis and cholestasis, and four (27%) had fulminant hepatic failure. Jaundice was not associated with mortality (p > 0.05), but it appeared to predict the length of hospital confinement. Early elevations in transaminase and alkaline phosphatase, a more than tenfold increase in alanine aminotransferase, and a severe derangement in prothrombin time all indicate poor prognosis. Metabolic acidosis and hypoglycemia were significantly associated with mortality (p < 0.01 and p < 0.05, respectively). The use of intravenous N-acetylcysteine did not significantly alter disease outcome (p > 0.05). Our mortality rate was 27%, confirming that yellow phosphorus is extremely lethal when ingested. Its indiscriminate use in the manufacture of fireworks should be eliminated.
authors.affiliation: Department of Medicine, Philippine General Hospital, Manila, Philippines.
authors.forename: O U
authors.initials: OU
authors.lastname: Fernandez
authors.forename: L L
authors.initials: LL
authors.lastname: Canizares
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000506:poisoning*; D011517:Prothrombin Time
chemical_list: D010758:Phosphorus; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000111:Acetylcysteine