Clinical profile and therapeutic outcomes of yellow phosphorus (Ratol) poisoning: A retrospective analysis at Kauvery Hospital, Trichy

Abstract

Background: Ingestion of yellow phosphorus (YP), primarily in the form of "Ratol" paste, is a leading cause of toxic hepatitis and fulminant hepatic failure (FHF) in Southern India. Despite the 2022 ban on 3% YP paste in Tamil Nadu, cases continue to present at tertiary centers.

Methods: A retrospective study of 67 patients admitted over one year in multispecialty tertiary care hospitals of Kauvery (Pan-Kauvery audit) was conducted. Data on demographics, formulation types, treatment (NAC and Plasmapheresis), and survival outcomes were analyzed.

Results: Of 67 cases, 67% were male (n=45). The "Paste" formulation was the primary toxicant (n=37). Management included N-acetylcysteine (NAC) and therapeutic plasma exchange (PLEX). The overall survival rate was 70.1%, with a 9% mortality rate and 21% discharged AMA.

Conclusion: Early initiation of NAC and PLEX as a "bridge to recovery" significantly improves survival in resource-limited settings where liver transplantation is not immediately available.