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. 2015 Jul;34(4):325-9.
doi: 10.1007/s12664-015-0583-2. Epub 2015 Aug 28.

Acute liver failure due to zinc phosphide containing rodenticide poisoning: Clinical features and prognostic indicators of need for liver transplantation

Vivek Saraf  1 , Supriya Pande  2 , Unnikrishnan Gopalakrishnan  1 , Dinesh Balakrishnan  1 , Ramachandran N Menon  1 , O V Sudheer  1 , Puneet Dhar  1 , S Sudhindran  3
Affiliations

Acute liver failure due to zinc phosphide containing rodenticide poisoning: Clinical features and prognostic indicators of need for liver transplantation

Vivek Saraf et al. Indian J Gastroenterol. 2015 Jul.

Abstract

Zinc phosphide (ZnP) containing rodenticide poisoning is a recognized cause of acute liver failure (ALF) in India. When standard conservative measures fail, the sole option is liver transplantation. Records of 41 patients admitted to a single centre with ZnP-induced ALF were reviewed to identify prognostic indicators for requirement of liver transplantation. Patients were analyzed in two groups: group I (n = 22) consisted of patients who either underwent a liver transplant (n = 14) or died without a transplant (n = 8); group II (n = 19) comprised those who survived without liver transplantation. International normalized ratio (INR) in group I was 9 compared to 3 in group II (p < 0.001). Encephalopathy occurred only in group I. Model for End-Stage Liver Disease (MELD) score in group I was 41 compared to 24 in group II (p < 0.001). MELD score of 36 (sensitivity of 86.7 %, specificity of 90 %) or a combination of INR of 6 and encephalopathy (sensitivity of 100 %, specificity of 83 %) were the best indicators of mortality. Such patients should undergo urgent liver transplantation.

Keywords: Acute liver failure; King’s College criteria; Zinc phosphide.

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