Angraje Srivatsa, Sekar Manikantan, Mishra Biswajit, Matcha Jayakumar
Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Indian J Crit Care Med. 2021 Sep;25(9):1020-1025. doi: 10.5005/jp-journals-10071-23971.
Yellow phosphorus (YP) is a protoplasmic poison that causes acute liver failure (ALF) for which liver transplantation is the definitive modality. Hereby, we present our clinical data on the role of plasma exchange (PE) in ALF due to YP poisoning when liver transplantation is not readily available.
Our study is a prospective observational type, conducted between January 2017 and January 2020, which included patients with ALF due to YP poisoning requiring PE. Clinical features, quantity of poison consumed, and laboratory data before and after PE were noted, and the outcome was documented.
This study had 10 patients. The mean age was 30 years. The ratio of male to female being 1.5:1. The amount of YP consumed (median) was 10 gm. Six patients consumed ≤10 gm and four consumed >10 gm. The mean of total PE sessions was 3.3. Seven patients (70%) had recovery from ALF, out of which five had consumed <10 gm of YP. Among patients who recovered after consuming YP, the mean day to get admitted to the hospital was 3.6 ± 1.81 ( = 0.017) and the time to start PE was 4.86 ± 1.67 days ( = 0.033). Three patients did not recover from ALF, of whom two expired. Peak total bilirubin (mg/dL) decreased to 2.76 from 9.29 ( = 0.005), serum glutamic oxaloacetic transaminase to 53.5 from 530 (IU/L) ( = 0.005), serum glutamic pyruvic transaminase to 54.5 from 378 (IU/L) ( = 0.005), international normalized ratio to 1.08 from 2.26 ( = 0.008), prothrombin time(s) decreased to 13.3 from 25.5 ( = 0.013), and activated partial thromboplastin time(s) to 24.6 from 40.8 ( = 0.007) post-PE sessions.
Our study revealed that the patient outcome depends on the quantity of poison consumed, duration of hospitalization, and time to start PE from the day of YP consumption. PE may be considered as a bridge to liver transplant in ALF patients.
Angraje S, Sekar M, Mishra B, Matcha J. Outcome of Plasma Exchange in Acute Liver Failure due to Yellow Phosphorus Poisoning: A Single-center Experience. Indian J Crit Care Med 2021;25(9):1020-1025.
黄磷（YP）是一种原生质毒物，可导致急性肝衰竭（ALF），肝移植是其最终治疗方式。在此，我们展示了在无法立即进行肝移植时，血浆置换（PE）在YP中毒所致ALF中的作用的临床数据。
我们的研究是前瞻性观察性研究，于2017年1月至2020年1月进行，纳入了因YP中毒需要PE的ALF患者。记录了临床特征、摄入毒物量以及PE前后的实验室数据，并记录了结果。
本研究有10例患者。平均年龄为30岁。男女比例为1.5:1。YP摄入量（中位数）为10克。6例患者摄入≤10克，4例患者摄入>10克。PE总疗程的平均值为3.3次。7例患者（70%）从ALF中康复，其中5例摄入的YP<10克。在摄入YP后康复的患者中，入院的平均天数为3.6±1.81天（P = 0.017），开始PE的时间为4.86±1.67天（P = 0.033）。3例患者未从ALF中康复，其中2例死亡。PE疗程后，总胆红素峰值（mg/dL）从9.29降至2.76（P = 0.005），血清谷草转氨酶从530降至53.5（IU/L）（P = 0.005），血清谷丙转氨酶从378降至54.5（IU/L）（P = 0.005），国际标准化比值从2.26降至1.08（P = 0.008），凝血酶原时间（秒）从25.5降至13.3（P = 0.013），活化部分凝血活酶时间（秒）从40.8降至24.6（P = 0.007）。
我们的研究表明，患者的预后取决于摄入毒物的量、住院时间以及从摄入YP之日起开始PE的时间。PE可被视为ALF患者肝移植的桥梁。
Angraje S, Sekar M, Mishra B, Matcha J. 黄磷中毒所致急性肝衰竭血浆置换的结果：单中心经验。《印度重症监护医学杂志》2021；25(9):1020 - 1025。
