Early aggressive activated charcoal treatment of elemental yellow phosphorus poisoning

An 18-month-old black male ingested approximately 65 mg of elemental yellow phosphorus contained in a rodenticide paste. Induced emesis, gastric lavage and administration of first dose of activated charcoal all were completed by 90 minutes after time of purported ingestion. Smoke was seen to be coming from the patient's mouth while vomiting. No garlic breath odor or oral mucosal burns were noted. Multiple dose activated charcoal was given every 4 hours over the next 24 hours. Serial electrocardiograms and liver function tests were followed. On day three liver span increased to 6 cm compared to admission liver span of 4 cm. Liver enzymes remained normal. The partial thromboplastin time rose to 53.5 seconds, but the prothrombin time remained normal. The BSP uptake on day 7 was normal. Follow-up long bone x-rays at 1 month revealed phosphorus bands in the metaphyses. The successful outcome in this case of ingestion of a potentially lethal dose of yellow phosphorus supports the efficacy of early aggressive gastro-intestinal decontamination. Multiple dose activated charcoal may accomplish enterohepatic trapping and enhance intestinal excretion of yellow phosphorus. Use of activated charcoal may be safer than previously used agents such as potassium permanganate or copper sulfate.