N-acetyl cysteine in the management of rodenticide consumption - life saving?
OBJECTIVE
Rodenticide is a commonly ingested poison in India. Many rodenticides contain hepatotoxic agents and can cause acute liver failure (ALF). There is no antidote for rodenticide poison, and consumption is often fatal. The Role of N acetyl cysteine (NAC) in acetaminophen induced ALF is well established. Additionally some studies have shown that it may be useful in non-acetaminophen induced ALF also. Cases with ALF secondary to suicidal rodenticide consumption have been reported, and some reports show that NAC is beneficial in these cases. Our study was a retrospective analysis of patients admitted with rodenticide consumption, comparing outcomes in those receiving standard of care management and those who were treated with NAC also.


METHODS
Case sheets of all inpatients of a tertiary medical college hospital between January 2010 and December 2012 admitted with an alleged history of rodenticide consumption were surveyed and data was extracted and analysed.


METHODS
Patients were analysed with respect to age, sex, mode of presentation, interval between consumption of rodenticide and starting NAC; the outcome in patients treated with acetylcysteine was compared to outcomes in those not treated with acetylcysteine


RESULTS
A total of 100 patients were studied out of which 18 died. Sixteen of the deaths were in patients who had not been treated with NAC. We found that patients who had received NAC had lower mortality, lower peak values of AST/ALT, and shorter hospital stay.


CONCLUSIONS
NAC may have a role in the management of ALF associated with rodenticide consumption.
Professor, Department of Medicine, Father Muller Medical College , Mangalore, India .
Smitha
S
Bhat
Post Graduate Resident, Department of Medicine, Father Muller Medical College , Mangalore, India .
Kumar P
KP
Kenchetty
Fulminant hepatic failure; Hepatotoxic; Poisoning