Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks

We reviewed 15 cases of poisoning from ingestion of yellow phosphorus-containing fireworks and analyzed its associated acute hepatotoxic effects. Two patients (13%) had no clinical or biochemical evidence of hepatic damage, four (27%) had subclinical hepatic injury, five (33%) manifested varying degrees of hepatocellular necrosis and cholestasis, and four (27%) had fulminant hepatic failure. Jaundice was not associated with mortality (p > 0.05), but it appeared to predict the length of hospital confinement. Early elevations in transaminase and alkaline phosphatase, a more than tenfold increase in alanine aminotransferase, and a severe derangement in prothrombin time all indicate poor prognosis. Metabolic acidosis and hypoglycemia were significantly associated with mortality (p < 0.01 and p < 0.05, respectively). The use of intravenous N-acetylcysteine did not significantly alter disease outcome (p > 0.05). Our mortality rate was 27%, confirming that yellow phosphorus is extremely lethal when ingested. Its indiscriminate use in the manufacture of fireworks should be eliminated.