SAT-451 PLASMA EXCHANGE IN YELLOW PHOSPHORUS POISONING-A SINGLE CENTRE STUDY

Abstract

Yellow phosphorus(YP) is one of the causes of rodenticide poison in developing countries especially India, due to easy availability, cheap cost & easy accessibility. Liver transplantation is the treatment of choice in patients with fulminant hepatic failure(FHF). Here we present our experience in dealing this poison with plasma exchange(PE) as the modality of treatment when liver transplantation is not an easily available option. In this prospective study, all patients of YP poisoning who had fulminant hepatic failure requiring plasma exchange were taken into the study. The study period was from January 2017 to June 2019. Clinical presentation, co-morbidities, poison form & amount, day of hospitalisation, day of initiation of plasma exchange, hepatic encephalopathy grade & baseline characteristics were noted. FHF was defined according to O'Grady/King's College criteria. History of ethanol consumption, prior liver disease documented. Laboratory data including Liver function test(LFT), Renal function test, coagulation parameters were noted serially before & after plasma exchange. Outcomes were documented as recovered or not recovered. Continuous variables were expressed as mean± Standard deviation or median and range according to test for normal distribution by using Shapiro-Wilk test. Friedman test was applied to check the continuous parameters at three different point of time. Independent-t test was used for statistical analysis where-ever required. A p-value of < 0.05 was considered statistically significant. A total of 10 patients were included in the study. 6 were males(60%) & 4 females(40%). Median age was 24.5 yrs. Seven patients(70%) recovered completely, 3 patients(30%) didn't recover. Among those 3 patients, one was referred for liver transplantation, one expired and one more had persistent liver dysfunction. 90% of patients had deliberate YP consumption, especially in paste form(90%). Among 7 patients who consumed < 20 gm of YP, 6 recovered(85.7%); whereas only one recovered(14.3%) among the rest who consumed ≥ 20 gm. 40% of patients received 2 sessions of PE, 30% received 5 sessions, 20% received 3 sessions and remaining 10% received 4 sessions. Mean sessions of PE was 3.5(2-5). For recovery, the mean day of hospitalization was 3.57 days(p=0.019) and for initiation of PE was 4.86 days(p=0.016) after consumption of YP. Peak median total bilirubin (mg/dl) prior to PE was 9.29 and decrease after PE was 2.76(p=0.005). Mean SGOT(IU/L) decreased from 819.8 to 61.4(p=0.005); SGPT(IU/L) from 457.8 to 65.8(p=0.005) ;INR from 3.24 to 1.4(p=0.008); PT(s) declined from 79.38 to 21.48(p=0.013);APTT(s) from 56.44 to 31.87 (p=0.007) post PE. Diabetes Mellitus & Hypertension didn't have any effect on the outcome. Out of 3 patients who had history of ethanol consumption, 2 recovered. The outcome of the patient depends on the amount of YP consumed; the day of hospitalization & initiation of PE from the day of YP consumption. Earlier the hospitalization &earlier the PE; more are the chances of recovery. Our experience suggests that PE is an effective approach for YP poisoning with 70% survival rate with improvement in LFT & coagulation parameters.