Deaths caused by ingestion of rat poison containing yellow phosphorus is a major problem in a few States. A six-month survey carried out in six districts in Tamil Nadu in 2019 by the Tamil Nadu chapter of Indian Society of Gastroenterology (TN-ISG) found 450 people suffered from liver toxicity caused by ingestion of rat poison. Of them, 131 patients died while 28 were discharged in a moribund state. Extrapolating it for the entire State, researchers estimated 1,584 such cases in 2019 in just six months with about 554 deaths. Tamil Nadu has introduced a legislation to curb unrestricted access to rodenticide containing yellow phosphorus.
Until a few years ago, urgent liver transplantation was the only life saving option for such patients who developed acute liver failure. Beginning December 2017, a team of researchers from CMC Vellore has been using plasma exchange through a centrifugal method — a simple and less expensive treatment — to save the lives of such people. Impressed by the success of the plasma exchange treatment by CMC Vellore and following the identification of rat poison (rodenticide) ingestion as the cause of liver failure and deaths, the Tamil Nadu government through the Tamil Nadu Accident and Emergency Care Initiative of the National Health Mission (TAEI-NHM) programme started using plasma exchange in six apex government hospitals to treat these patients in March 2022. Prior to this, Madras Medical College, Stanley Medical College in Chennai and Coimbatore Medical College were using plasma exchange to treat rodenticide hepatotoxicity. Currently, 17 government hospitals across 15 districts in the State undertake plasma exchange to treat rodenticide-induced acute liver injury and acute liver failure cases.
“In 2022-2023, 1,237 acute liver toxicity patients due to rat poisoning in Tamil Nadu were treated with plasma exchange. Of them, 825 survived and were discharged. The survival rate was 63.9%,” says Dr. Maruthu Thurai Sambandam, Tamil Nadu State Programme Manager, TAEI-NHM.
