Intoxicación por fósforo blanco

Intoxicación por fósforo blanco

White phosphorus, the form of elemental phosphorus still used as a rodenticide in some parts of the world, is highly poisonous, a human ingestion of 50 mg or 1 mg/kg. may be fatal (7). In Colombia white phosphorus is used as pyrotechnics “totes” in Christmas time.
When used as a rodenticide, is usually mixed with molasses or peanut butter and spread on bread as bait for rodents or roaches. For obvious reasons, rodenticides deployed in this manner may be unintentionally ingested by children or compromised adults. Contact with white phosphorus causes second and third degree skin bums within minutes to hours.
White phosphorus is most immediately toxic to the gastrointestinal tract and liver and ingestion are usually followed by a peculiar type of vomiting, described as “smoking”, luminescent, and with a garlicky odor. Resultant stools may also be luminescent and “smoking” (2).
Delirium, coma, and death from cardiovascular collapse may ensue. White phosphorus has a direct toxic effect on the myocardium and peripheral vessels. Experimentally, acute phosphorus poisoning depresses rat myocardial protein synthesis (3).
Patients who survive the acute effects of white phosphorus poisoning may then have a relatively symptom-free period lasting for a few weeks, only to experience a third stage of systemic toxicity involving the gastrointestinal tract, liver, kidney, and central nervous system.
Treatment for white phosphorus poisoning in the past and present has included orogastric lavage with potassium permanganate 0.1% solution, or 3% hydrogen peroxide diluted to a 2% solution to oxidize the phosphorus to harmless phosphates, followed by the use of activated charcoal and possibly a cathartic. These approaches have not been adequately investigated. Neither corticosteroids, which had been previously recommended, nor exchange transfusions appear to be useful; in one group of 49 suicidal patients from Colombia, corticosteroids did not prevent coma or death from hepatic injury. In another group of 15 patients with hepatic encephalopathy, 3 of 5 patients treated with exchange transfusions survived as compared to 3 of 10 untreated patients (4).