Phosphide-induced Liver Injury - The “Drug-induced Liver Injury” Dilemma
Introduction: Phosphide containing rodenticide poisoning is a recognized cause of acute liver failure (ALF). Its treatment has a myriad of obstacles and treatment modalities range from medical (N-acetyl cysteine) to surgical (liver transplantation). We report five cases of drug-induced liver injury (DILI) following ingestion of phosphide containing rodenticide for suicidal purpose and their outcomes. Methods: Retrospective analysis of five cases of the phosphide containing rodenticide poisoning admitted to St. John’s Medical College Hospital during the period of 2015–2017. Results: All five patients were females with median age of 25 years (range 24–31). None had history of alcohol consumption, chronic liver disease, or other comorbidities. All five patients were nursed in intensive care unit (ICU). During the course of stay, all patients had deranged liver function test and coagulation profile. Complications noted during the period were acute kidney injury (80%, n = 4), of which three required hemodialysis, worsening metabolic acidosis (60%, n = 3) and adult respiratory distress syndrome (40%, n = 2) requiring mechanical ventilation. Two patients (40%) recovered with conservative management (N-acetyl cysteine) and three patients (60%) succumbed to their illness in ICU. Average length of stay was 11.2 days (5–21) with recovery noted in patients who presented early. Conclusion: ALF due to DILI affects young individuals and has high risk of morbidity and mortality. As there is no effective antidote, liver transplantation often remains the only lifesaving therapy. Regularly used criteria for transplantation do not address phosphide poisoning, and hence, a scoring model for the same is warranted.