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BACKGROUND: Yellow phosphorus (YP) is a protoplasmic poison that causes acute liver failure (ALF) for which liver transplantation is the definitive modality. Hereby, we present our clinical data on the role of plasma exchange (PE) in ALF due to YP poisoning when liver transplantation is not readily available. METHODS: Our study is a prospective observational type, conducted between January 2017 and January 2020, which included patients with ALF due to YP poisoning requiring PE. Clinical features, quantity of poison consumed, and laboratory data before and after PE were noted, and the outcome was documented. RESULTS: This study had 10 patients. The mean age was 30 years. The ratio of male to female being 1.5:1. The amount of YP consumed (median) was 10 gm. Six patients consumed ≤10 gm and four consumed >10 gm. The mean of total PE sessions was 3.3. Seven patients (70%) had recovery from ALF, out of which five had consumed <10 gm of YP. Among patients who recovered after consuming YP, the mean day to get admitted to the hospital was 3.6 ± 1.81 (p = 0.017) and the time to start PE was 4.86 ± 1.67 days (p = 0.033). Three patients did not recover from ALF, of whom two expired. Peak total bilirubin (mg/dL) decreased to 2.76 from 9.29 (p = 0.005), serum glutamic oxaloacetic transaminase to 53.5 from 530 (IU/L) (p = 0.005), serum glutamic pyruvic transaminase to 54.5 from 378 (IU/L) (p = 0.005), international normalized ratio to 1.08 from 2.26 (p = 0.008), prothrombin time(s) decreased to 13.3 from 25.5 (p = 0.013), and activated partial thromboplastin time(s) to 24.6 from 40.8 (p = 0.007) post-PE sessions. CONCLUSIONS: Our study revealed that the patient outcome depends on the quantity of poison consumed, duration of hospitalization, and time to start PE from the day of YP consumption. PE may be considered as a bridge to liver transplant in ALF patients. HOW TO CITE THIS ARTICLE: Angraje S, Sekar M, Mishra B, Matcha J. Outcome of Plasma Exchange in Acute Liver Failure due to Yellow Phosphorus Poisoning: A Single-center Experience. Indian J Crit Care Med 2021;25(9):1020-1025.
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Introduction: Hypertension (HT) is a common and challenging problem in patients on dialysis. Routine peri-dialytic blood pressure (BP) recordings are unable to diagnose HT accurately and stratify cardiovascular risk. We report here an analysis of 2 years, single-center experience on 24-hour ambulatory blood pressure monitoring (ABPM) in elderly hemodialysis patients in the interdialytic period. Materials and Methods: Data of all the patients above 65 years of age undergoing hemodialysis between November 2017 and December 2019 in our hemodialysis unit and for whom 24-hour ABPM was done were collected. Demographics, clinical profile, pre- and post-dialysis BP recordings, 24-hour ABPM characteristics, and the outcome status were analyzed. Results: Of the 37 patients, 28 (75.7%) were males with a mean age of 67.73 years; 67.6% were diabetic. HT was found in all patients (100%), and uncontrolled HT was noted in 30 (81%) patients by ABPM. Patients with uncontrolled HT were also nondippers of BP (100%). A significant association was observed between nondippers and coronary artery disease (n = 27, 90%, P = 0.004). Masked HT was found in 9 (24.3%) patients with normal peridialytic BP (n = 9, 24.3%, P = 0.000). No significant difference was noted between diabetic and nondiabetic patients regarding dipping status or mortality. Among 37 patients, 9 (24.3%) died during follow-up with uncontrolled HT as a significant risk factor (P = 0.05). Conclusion: The prevalence of uncontrolled HT with blunted circadian rhythm was high as detected by ABPM in the interdialytic period among elderly hemodialysis patients and had a significant impact on mortality. Masked uncontrolled HT as measured by ABPM was not uncommon in patients with normal peridialytic BP.