Inorganic phosphorus poisoning

　　Childhood poisoning is often due to accidental ingestion of rodenticides containing phosphorus, such as zinc phosphide (zincphosphide), or occasionally from swallowing match heads containing yellow phosphorus; if a child repeatedly chews the edges of matchboxes containing phosphides or red phosphorus, poisoning symptoms may also occur, as red phosphorus generally contains 0.6% to 1% yellow phosphorus. Inhaled yellow phosphorus smoke or phosphine poisoning is rare.

　　1. The toxicity of yellow phosphorus is very severe, with the minimum lethal dose for adults approximately 60-100mg, and the lethal dose of zinc phosphide is about 40mg/kg.

　　2. After entering the human body, the toxicological effect of yellow phosphorus is to disrupt the function of intracellular enzymes, primarily causing damage to the liver, heart, kidneys, and other vital organs. It can also cause fatty changes in the above organs and striated muscles, peripheral circulatory failure, decalcification of bones, and bleeding. In addition, yellow phosphorus can cause severe burns and corrosion to the skin and mucous membranes, and can be absorbed into the body through wounds, leading to poisoning.

　　3. When zinc phosphide enters the body, it reacts with stomach acid to produce phosphine and zinc chloride, both of which have irritant and corrosive effects on the gastrointestinal mucosa, causing inflammation, congestion, ulcers, and bleeding. The phosphine produced also acts on cellular enzymes, affecting cell metabolism, leading to cellular asphyxia, and consequently affecting the central nervous system, respiratory, cardiovascular, and renal functions, with the central nervous system being the most affected and severely damaged.

　　Severe cases may present with acute liver necrosis, liver failure, liver coma, accompanied by renal damage, which may include hematuria, proteinuria, casts in urine, oliguria, anuria, and elevated blood urea nitrogen, indicating renal dysfunction or failure. In addition to liver and renal damage, other organs may also be affected. The toxicity of yellow phosphorus is very severe, with the minimum lethal dose for adults approximately 60-100mg, and the lethal dose of zinc phosphide is about 40mg/kg. After entering the human body, yellow phosphorus disrupts the function of intracellular enzymes, primarily causing damage to the liver, heart, kidneys, and other vital organs. It can also cause fatty changes in the above organs and striated muscles, peripheral circulatory failure, decalcification of bones, and bleeding. In addition, yellow phosphorus can cause severe burns and corrosion to the skin and mucous membranes, and can be absorbed into the body through wounds, leading to poisoning. When zinc phosphide enters the body, it reacts with stomach acid to produce phosphine and zinc chloride, both of which have irritant and corrosive effects on the gastrointestinal mucosa, causing inflammation, congestion, ulcers, and bleeding. The phosphine produced also acts on cellular enzymes, affecting cell metabolism, leading to cellular asphyxia, and consequently affecting the central nervous system, respiratory, cardiovascular, and renal functions, with the central nervous system being the most affected and severely damaged.

　　1. After accidentally ingesting phosphides (such as zinc phosphide), in addition to gastrointestinal symptoms, pulmonary edema and jaundice may occur rapidly, accompanied by neurological symptoms such as dizziness, general numbness, convulsions, confusion, and coma, as well as cardiovascular symptoms such as palpitations, blood pressure drop, bradycardia, and myocardial damage.

　　2. Within half an hour to several hours after accidentally ingesting match heads containing yellow phosphorus or other phosphorus compounds, patients may experience burning pain in the mouth, esophagus, and stomach, along with nausea, vomiting, abdominal pain, and diarrhea. The vomit and feces have a garlic-like odor, and fluorescence can be seen in the dark. Mild cases can gradually recover within a week. Severe patients may have blood-tinged vomit and feces, and even massive hemorrhage, leading to coma, shock, and death within 1 to 2 days.

　　3. When a large amount is accidentally ingested, shock can occur rapidly without obvious vomiting, abdominal pain, or diarrhea.

　　4. Some patients may develop symptoms of absorption poisoning after 1 to 3 days of symptom improvement, with symptoms such as vomiting, diarrhea, abdominal pain, blood-tinged vomit and diarrhea, liver enlargement, jaundice, epistaxis, and subcutaneous hemorrhage. Severe cases may experience respiratory distress, spasms, liver and kidney failure, delirium, blood pressure drop, and coma, and may die within 1 to 3 weeks. A few patients may develop esophageal or gastrointestinal perforation due to corrosion.

　　5. Inhalation of a large amount of yellow phosphorus smoke or phosphine can cause respiratory distress within a few minutes, followed by symptoms such as pulmonary edema, which can lead to death in a short period of time.

　　Do not let children play with matches. Rodenticide should be marked and placed next to mouse holes at night, removed during the day to prevent children from picking them up and accidentally ingesting them; unused rodenticide should be properly stored. Educate children not to play in places vaporized with phosphine or other phosphorus compounds.

　　The items to be checked include:

　　1. Abnormal vomit and feces. Phosphorus can be detected, and it may emit phosphorescence at night or in the dark.

　　2. Routine blood tests. A decrease in white blood cells and platelets, as well as a decrease in blood sugar, can be seen.

　　3. Blood biochemistry. Increased levels of cholesterol, bilirubin, phosphorus, and calcium can be observed, with a decrease in prothrombin and prolonged coagulation and clotting times.

　　4. Urinalysis. Reduced urine volume may result in the presence of protein, red blood cells, and casts.

　　Nutrition should be high in calories and vitamins, and also need rich proteins. In terms of diet, eat more fresh vegetables and fruits. Avoid spicy and fried foods such as chili, strong alcohol, fried fish, fried chicken, oil sticks, fried shrimps, scallion oil large ribs, and other similar foods. These foods will 'generate heat and fire', which is not suitable for myocarditis.

　　Recommended medicine: Monkey Head Mushroom Peacock Soup

　　Ingredients: Peacock meat, truffle, lean pork, Chinese yam, mung beans, lotus seeds, one piece of dried tangerine peel.

　　Preparation: First blanch the peacock meat and lean pork in boiling water, then put the above ingredients together in a pot, boil and then simmer for two hours over low heat.

　　For those who are poisoned by oral intake without gastric bleeding, they must immediately use a 1:5000 potassium permanganate solution or a 0.1% copper sulfate solution to carefully wash the stomach within 5 hours until the effluent is clear without garlic smell; if it is not possible to wash the stomach immediately, then an appropriate amount of 0.5% copper sulfate solution can be taken internally (4ml for adults, reduced proportionally for children), taken once every 15 minutes, for a total of 2-3 times or until vomiting occurs (patients in a coma should still be washed). It must be noted that the copper sulfate solution used should not be too concentrated or too much, and the in and out volume of the gastric lavage fluid should be roughly equal to prevent copper poisoning. It is also possible to first infuse an appropriate amount of liquid paraffin into the stomach, and then wash the stomach with a large amount of clean water. After lavage, continue to give sodium sulfate or liquid paraffin as a laxative for several days, as these toxic substances can still be detected in the feces 2-3 days after ingestion of phosphorus. Magnesium sulfate should be avoided as it can react with zinc chloride (one of the products formed when phosphine is encountered by phosphorus in the stomach) to form halide, causing poisoning. Liquid paraffin can dissolve phosphorus and be excreted, and is not absorbed by the gastrointestinal tract. Do not use other oils or fatty substances such as milk to prevent the promotion of phosphorus absorption. Intravenous injection of an appropriate amount of 50% glucose solution and a large amount of vitamin C, as well as liver-protecting drugs. Severe patients can be treated with blood exchange therapy. When there is bleeding, vitamin K, carboxyamino guanidine, and other hemostatic drugs should be selected according to the condition. The rest is intravenous fluid therapy, maintenance of nutrition, and symptomatic treatment. If the child is poisoned by phosphorus smoke or phosphine, quickly move the child to fresh air, change contaminated clothes; if the skin is contaminated, immediately rinse the skin with a 1% copper sulfate solution, a 2% sodium bicarbonate solution, or a 2% hydrogen peroxide solution; the rest is for treating pulmonary edema, and treatment should be carried out according to the above-mentioned items.