A study on the role of n-acetyl cysteine in yellow phosphorous poisoning (ratol) and postmortem toxicological findings

Context: Ratol is a rodenticide (rat killer paste) ,it contains yellow phosphorus, a severe local and systemic toxin causing damage to gastrointestinal, hepatic, cardiovascular, and renal systems. Among these liver is the most commonly affected organ and acute liver failure with coagulopathy is the most dreaded complication. These toxins damages the liver by depleting glutathione stores. NAC acts by stimulating the glutathione synthesis and enhances glutathione transferase activity.Therefore, treatment with NAC, which is inexpensive and relatively safe, would be a viable treatment option for patients admitted with yellow phosphorous consumption with ALF but those who are not eligible for liver transplant. Aim of The Study: 1. To study the prevalence of yellow phosphorus poisoning in our hospital 2. To evaluate the usefulness of N-Acetyl cysteine in yellow phosphorous poisoning 3. Postmortem findings in liver and kidney. Settings and Design: Prospective cross sectional observational study. Materials and Methods: The study was conducted on 25 patients with history of yellow phosphorous poison (ratol) consumption who fulfill the inclusion and exclusion criteria getting admitted at Government Rajaji Hospital & Madurai Medical College during the period of June to September 2017. • The control group patients are taken from retrospective data obtained in year 2016 at GRH, who had similar management protocol except for NAC. Results: Morbidity and Mortality was reduced to 50% in the study group who was admitted early and treated with NAC, even though they consumed lethal dose of Ratol. Conclusions: Most patients admitted with history of suicidal consumption of ratol (yellow phosphorous) were young and belonged to poorer socio-economic sections. Therefore treatment with NAC, which is inexpensive and relatively safe, would be a viable treatment option for patients admitted with ratol consumption.