ABSTRACT

Extremely toxic yellow phosphorus exists in the exploding fun toy known as fire cracker among people. In this report, we aimed to present a yellow phosphorus poisoning case referred to our Pediatric Emergency Department due tovomiting and fever.

A 7-year-old boy was brought to the Pediatric Emergency Department due to vomiting and history of firecracker ingestion10 hours ago. His physical examination was normal. According to his first laboratory investigations, Hb was 13.1 g/dL, WBC was 5200/mm3 and thrombocyte count was 254.000/mm3. The blood gas, liver function tests, PTT and INR activity were in normal range. However, after documentation of his high serum phosphorus level (5.9 mg/dL), the patient was admitted to the intensive care unit (ICU) considering acute phosphorus toxicity, and alkalinisation treatment was started. Follow- up laboratory measurements indicated that serum phosphorus, liver functions tests, bleeding parameters were normal. He was discharged after 72 hours with observation of adequate oral intake. Two days after his discharge, he had a second admission to the Emergency Department due to recurrence of fever and vomiting. Due to elevated liver enzymes and abnormal coagulation tests, (ALT 957 U/L,AST 434 U/L, INR 2.1, PT 20.7 sec., PTT 62.7 sec.), he was transferred to the ICU. Vitamin K, fresh frozen plasma and intravenous N-Acetyl cystein (100 mg/kg) treatments were introduced. His hepatitis serology was negative and infectious causes were not likely. The liver function tests and INR became normal at follow-up investigations of the patient.

Although it had been restricted due to extremely toxic effects, yellow phosphorus remains to be used in firecrackers. This substancecan be deposited within the tissues and may induce acute liver failure and be lethal if no transplantation is performed. Therefore emergency staff should be aware of yellow phosphorus intoxication due to firecracker ingestion as well as other ingestions in a child presenting with vomiting.

Keywords: Yellow phosphorus, firework cracker, acute hepatic failure