Intoxication by white phosphorus. Report of two cases

Abstract

INTRODUCTION: White phosphorus is a fat-soluble substance that is absorbed mainly by the gastrointestinal tract, toxic to humans, used for pyrotechnics and ammunition. Its lethal dose in humans is 50-60 mg or 1 mg per kilogram of weight; hepatoxicity is due to the generation of free radicals that damage the outer membrane of the hepatocyte. In Ecuador there are no statistics on white phosphorus intoxication. Clinically, symptoms present in four stages: the first is characterized by gastrointestinal symptoms that evolve to progressive asymptomatic liver damage, followed by clinical symptoms of liver damage such as jaundice and coagulation disorder, and finally, stage IV presents with multiorgan failure. 

CASE PRESENTATION: It describes two cases of patients aged 13 and 15 years with ingestion of "diablillos" (white phosphorus) as an autolytic attempt to develop alterations in coagulation times and liver function, classified as clinical stages II and III; whose management is based on N-acetylcysteine, Vitamin K, Lactulose and especially Hemodialysis and Hemoperfusion. EVOLUTION: In spite of the rapid evolution to clinical stages where a high risk of morbidity and mortality has been evidenced, with the therapy performed, normalization of liver function is achieved in approximately 9 days with a satisfactory recovery, effectively reducing hospitalization time and sequelae in the affected organs.  CONCLUSIONS: It is considered that hemoperfusion therapy in cases of severe phosphorus intoxication allows an evident clinical improvement, avoiding mortality and permanent liver damage.