yellow phosphorous poisoning
yellow phosphorous poisoning
yellow phosphorous was once used as a rat or roach poison . Fire works and fertilizers manufactures
which release phosphine on contact with water.
DOSE:
The fatal dose of yellow phosphorous or phosphite is approximatyely 1mg/kg.
The exposure limit for yellow phosphorous is 0.1 mg/m3; for phosphine , 0.3 ppm;and for phenyl
phosphine,0.05ppm.
Symptoms:
phosphorous causes tissue destruction , with disturbanxce in carbohydrate, fat, protein metabolism in
the liver. Deposition ofglycogen in liver is inhibited; deposition of fat is increased.
Chronic absorption of phosphorous increases bone formation under the epiphyseal cartilage and
impairs blood circulation in bone by bone formation in haverian and marrow canals. These changes
lead to necrosis and sequestration of bone; they occur most frequentlyu in the mandible.
The pathologic findings in yellow phosphorous poisoning are jaundice, fatty degeneration and
necrosis of the liver and kidney, and hemorrhages, congestion, and erosion of the gastrointestinal
tract. Pathologic findings from phosphine inhalation are pulmonary hypeeremia and edema and focal
myocardial necrosis.
CLINICAL FINDINGS:
The principle manifestations of poisoning with these compounds are jaundice and collapse.
A. ACUTE POISONING:
1. ingestion- Injestion of yellow phosphorous is followed with in one to two hours by nausea
and vomiting, Diarrhoea, cardiac arrhythmias, and a garlic odour of breath and excreta. The
breath and excreta may appear to smoke.Death in coma or cardiac arrest may occur in the first
24 to 48 hours, or symptoms may improve for one to two days and then return, with nausea
and vomiting, Diarrhoea, liver tenderness and enlargement, jaundice,prostration, fallof blood
pressure, oliguria, hypocalcemic tetany, hypoglycemia, and multiple hemorrhages. On set of
cheynestokes respiration followed by convulsion ,coma and death may occur upto three weeks
after poisoning. Phosphide ingestion causes jaundice, liver tenderness and enlargement, and
pulmonary edema with dyspnea and cyanosis.Death may occur upto a week after poisoning.
2. Skin contact- yellow phosphorous allowed to dry in the skin will ignite and cause second to
third degree burns surrounded by blistters. These burns heal slowly.
3. Inhalation – inhalation of phosphorous is followed after one to three days by the symptoms of
acute phosphorous poisoning. Renal damage and leukopenia may appear after several days.
B. CHRONIC POISONING:
The first symptom is tooth ache , followed by swelling of the jaw and then necrosis of the mandible
(phossy jaw). Other findings are weakness, weight losss, loss of appetite,anaemia and spontanious
fractures.
C. LABORATORY FINDINGS:
1. impairment of liver function is shown by appropriate tests
2. Blood urea nitrogen and billirubin are increased. Acidosis may occur .
3. Hematuria and proteinuria may be present
PREVENTION :
The exposure limit for phosphorous ,phosphine and phosphides in the air must be observed at all
times .special clothing,to be changed daily, should be provided for phosphorous workers.workers must
bath on leaving work and must be educated in the hazards of phosphorous exposure.safety showers
and eye fountains must be provided where yellow phosphorous is being used. Dental examination
should be made frequently depending on exposure.
TREATMENT:
A. ACUTE POISONING:
1. Emergency measures:
Remove poisoning by gastric lavage with 5 to 10 litres of tap water.If a gatrictube is not immediately
available, induce emesis. Remove phosphorous contamination from the skin or eyes by copious
irrigation with tap water for atleast 15 minutes.
2. General measures:
Treat pulmonary edema and shock.. give 10% calcium gluconate, 10ml I.V,to maintain serum
calcium. Give 1 to 4 litres of 5% glucose in wateror 10 % invert sugar in water I. V daily until a high
carbohydrate diet can be given by mouth. Treat hepatic failure.
B. CHRONIC POISONING:
Remove from furthur exposure .Treat jaw necrosis by surgical excision of sequestered bone.
Prognosis:
In poisoning from ingestion of phosphorous, the mortality rate is about 50%. In phosphine inhalation ,
survival for 4 days is ordinarily followe by recovery.
Reference:
1. Hand book of poisoning . Robert H. Dreisbach/ william O. Robertson. Twelth edition. Lange
medical book.
yellow phosphorous was once used as a rat or roach poison . Fire works and fertilizers manufactures
which release phosphine on contact with water.
DOSE:
The fatal dose of yellow phosphorous or phosphite is approximatyely 1mg/kg.
The exposure limit for yellow phosphorous is 0.1 mg/m3; for phosphine , 0.3 ppm;and for phenyl
phosphine,0.05ppm.
Symptoms:
phosphorous causes tissue destruction , with disturbanxce in carbohydrate, fat, protein metabolism in
the liver. Deposition ofglycogen in liver is inhibited; deposition of fat is increased.
Chronic absorption of phosphorous increases bone formation under the epiphyseal cartilage and
impairs blood circulation in bone by bone formation in haverian and marrow canals. These changes
lead to necrosis and sequestration of bone; they occur most frequentlyu in the mandible.
The pathologic findings in yellow phosphorous poisoning are jaundice, fatty degeneration and
necrosis of the liver and kidney, and hemorrhages, congestion, and erosion of the gastrointestinal
tract. Pathologic findings from phosphine inhalation are pulmonary hypeeremia and edema and focal
myocardial necrosis.
CLINICAL FINDINGS:
The principle manifestations of poisoning with these compounds are jaundice and collapse.
A. ACUTE POISONING:
1. ingestion- Injestion of yellow phosphorous is followed with in one to two hours by nausea
and vomiting, Diarrhoea, cardiac arrhythmias, and a garlic odour of breath and excreta. The
breath and excreta may appear to smoke.Death in coma or cardiac arrest may occur in the first
24 to 48 hours, or symptoms may improve for one to two days and then return, with nausea
and vomiting, Diarrhoea, liver tenderness and enlargement, jaundice,prostration, fallof blood
pressure, oliguria, hypocalcemic tetany, hypoglycemia, and multiple hemorrhages. On set of
cheynestokes respiration followed by convulsion ,coma and death may occur upto three weeks
after poisoning. Phosphide ingestion causes jaundice, liver tenderness and enlargement, and
pulmonary edema with dyspnea and cyanosis.Death may occur upto a week after poisoning.
2. Skin contact- yellow phosphorous allowed to dry in the skin will ignite and cause second to
third degree burns surrounded by blistters. These burns heal slowly.
3. Inhalation – inhalation of phosphorous is followed after one to three days by the symptoms of
acute phosphorous poisoning. Renal damage and leukopenia may appear after several days.
B. CHRONIC POISONING:
The first symptom is tooth ache , followed by swelling of the jaw and then necrosis of the mandible
(phossy jaw). Other findings are weakness, weight losss, loss of appetite,anaemia and spontanious
fractures.
C. LABORATORY FINDINGS:
1. impairment of liver function is shown by appropriate tests
2. Blood urea nitrogen and billirubin are increased. Acidosis may occur .
3. Hematuria and proteinuria may be present
PREVENTION :
The exposure limit for phosphorous ,phosphine and phosphides in the air must be observed at all
times .special clothing,to be changed daily, should be provided for phosphorous workers.workers must
bath on leaving work and must be educated in the hazards of phosphorous exposure.safety showers
and eye fountains must be provided where yellow phosphorous is being used. Dental examination
should be made frequently depending on exposure.
TREATMENT:
A. ACUTE POISONING:
1. Emergency measures:
Remove poisoning by gastric lavage with 5 to 10 litres of tap water.If a gatrictube is not immediately
available, induce emesis. Remove phosphorous contamination from the skin or eyes by copious
irrigation with tap water for atleast 15 minutes.
2. General measures:
Treat pulmonary edema and shock.. give 10% calcium gluconate, 10ml I.V,to maintain serum
calcium. Give 1 to 4 litres of 5% glucose in wateror 10 % invert sugar in water I. V daily until a high
carbohydrate diet can be given by mouth. Treat hepatic failure.
B. CHRONIC POISONING:
Remove from furthur exposure .Treat jaw necrosis by surgical excision of sequestered bone.
Prognosis:
In poisoning from ingestion of phosphorous, the mortality rate is about 50%. In phosphine inhalation ,
survival for 4 days is ordinarily followe by recovery.
Reference:
1. Hand book of poisoning . Robert H. Dreisbach/ william O. Robertson. Twelth edition. Lange
medical book.
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