Hemoperfusión en intoxicación por fósforo blanco.

Abstract

Introduction: White phosphorus is commonly used in pyrotechnic products. When ingested, it can cause gastrointestinal, hepatic, and renal alterations, circulatory collapse, and neurotoxicity. There is no antidote, and a treatment option may be hemoperfusion, which is why the management of this case is presented. Clinical case: 26-year-old man who comes with ingestion of 100 mg white phosphorus in the form of 5 pyrotechnic pills (1.41 mg/kg) 5 hours previously. The physical examination showed arterial hypertension 158/92 mm Hg; the rest of the examination was regular. Hemoglobin 17.8 g/dl, Cholinesterase 13216 U/L, ketonuria 150 mg/dl, toxicology negative for amphetamines, barbiturates, benzodiazepines, cocaine, marijuana, methadone, methamphetamines, opiates, and antidepressants. Management: Gastric lavage was performed with 10% sodium bicarbonate (20 ampoules) plus 1000 ml of 0.9% Sodium Chloride. He was hydrated with 0.9% Saline Solution 100 ml/hour, Omeprazole 40 mg intravenously, and Acetylcysteine in continuous infusion. Vascular access was placed, and he underwent four sessions of Hemoperfusion (Jafron HA230 activated carbon) every 12 hours for 3 hours. Evolution: In the third year, there was an increase in TGP of 1002 U/l; the INR was 4.56. Severe acute hepatitis was diagnosed without encephalopathy and acute liver failure. Four additional sessions of hemoperfusion were performed, and vitamin K and Acetylcysteine were simultaneously received. On the 6th day, the TGP value decreased to 128 U/L and the INR normalized. He was discharged in good condition. Conclusion: Hemoperfusion in 8 sessions, in this case of severe white phosphorus poisoning, prevented liver failure and mortality.