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GUIDELINE
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 1-6

Management of rodenticide poisoning: Tamil Nadu chapter of Indian Society of gastroenterology guidelines


1 Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
2 Tamil Nadu Gastroenterologist Trust, Chennai, Tamil Nadu, India
3 Department of Medical Gastroenterology, Thanjavur Medical College, Thanjavur, Tamil Nadu, India
4 Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
5 Department of Gastro Sciences, Advanced Endoscopy and Liver Diseases, MGM Health Care, Chennai, Tamil Nadu, India
6 Department of Medical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
7 Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
8 Department of Medical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India
9 Institute of Gastroenterology, Hepatobiliary Science and Transplantation, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India
10 Department of Medical Gastroenterology, Thoothukudi Medical College, Thoothukudi, Tamil Nadu, India
11 Department of Medical Gastroenterology, Stanley Medical College, Chennai, Tamil Nadu, India
12 Department of Gastroenterology and Hepatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

Correspondence Address:
Chundamannil Eapen Eapen
Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ghep.ghep_45_21

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Rodenticide ingestion, a common mode of suicide in Tamil Nadu and other states in southern and western parts of India, can lead to hepatotoxicity and death. Most rodenticide agents contain phosphorus, a potent toxin. The only definitive management in a patient who develops rodenticide induced acute liver failure is urgent liver transplantation. A study conducted across Tamil Nadu in 2019 documented that the majority (>99%) of rodenticide hepatotoxicity patients cannot access urgent liver transplantation. The current guidelines proposed by the Tamil Nadu chapter of the Indian Society of Gastroenterology are focused on improving survival in these patients, especially by nontransplant treatments. The indications for the use of plasma exchange, an emerging treatment which improves survival in acute liver failure, are described. In resource-constrained settings, it is preferable to avoid the use of sedative drugs, in rodenticide hepatotoxicity patients, who do not have encephalopathy. These management guidelines are specifically meant for use by doctors in primary health centers and in secondary hospitals who care for patients with rodenticide ingestion and hepatotoxicity. We hope these guidelines may also help inform health care policy in Tamil Nadu state to improve survival in patients with rodenticide hepatotoxicity by cost-effective interventions.


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