Acute on chronic liver failure presentation of zinc phosphide poisoning: a concept elucidating case report

Abhilash Haridas, Payal Mukker, Shine Hameed, Ajith PG


Zinc phosphide is an inorganic compound that is used as a rodenticide. A case of a young female is described who developed acute on chronic liver failure (ACLF) precipitated by deliberate self-harm (DSH) with zinc phosphide. She had underlying cirrhosis due to surreptitious alcohol intake. She recovered propitiously following meticulous intensive care management of the acute event. This case in itself elucidates the concept of ACLF.


Zinc phosphide, DSH, ACLF

Full Text:



Pillay VV, Arathy SL, Vijesh KP, Vipin KG. Five year survey of toxicological testing of clinical body fluid samples at the poison control centre in the indian state of kerala. J Indian Acad Forensic Med. 2010;32(01):52-5.

Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, Daivadanam M, Soman B, Vasan RS. Risk factor profile for chronic non-communicable diseases: results of a community-based study in kerala, india. Indian J Med Research. 2010;131:53-63.

Trey C, Davidson CS. The management of fulminant hepatic failure. In: Popper H, Schaffner F, eds. Progress in liver diseases. New York: Grune and Stratton; 1970:282-98.

Reuben A, Koch DG, Lee WM. Drug‐induced acute liver failure: results of a us multicenter, prospective study. Hepatology. 2010;52(6):2065-76.

Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, et al. Acute on chronic liver failure: consensus recommendations of the asian pacific association for the study of the liver (APASL). Hepatol Int. 2009;3(1):269-82.

Katoonizadeh A, Laleman W, Verslype C, Wilmer A, Maleux G, Roskams T, et al. Early features of acute on chronic alcoholic liver failure: a prospective cohort study. Gut. 2010;59(11):1561-9.

Finkenstedt A, Nachbaur K, Zoller H, Joannidis M, Pratschke J, Graziadei IW, et al. Acute on chronic liver failure: excellent outcomes after liver transplantation but high mortality on the wait list. Liver Transpl. 2013;19(8):879-86.

Saleki S, Ardalan FA, Javidan-Nejad A. Liver histopathology of fatal phosphine poisoning. Forensic Sci Int. 2007;166:190-3.

Gökdemir MT, Kaya H, Söğüt O, Orak M, Üstündağ M, Karasu M. A rare type of suicide attempt in east turkey: acute zinc phosphide poisoning. JAEM. 2013;12:76-9.

Saraf V, Suhas RK, Dattaram U, Binoj ST, Menon R, Dinesh B, et al. Predictors for need for liver transplantation in acute zinc phosphide poisoning. J Clin Exp Hepatol. 2011;1(2):142.