Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks

J Clin Gastroenterol. 1995 Sep;21(2):139-42. doi: 10.1097/00004836-199509000-00015.


We reviewed 15 cases of poisoning from ingestion of yellow phosphorus-containing fireworks and analyzed its associated acute hepatotoxic effects. Two patients (13%) had no clinical or biochemical evidence of hepatic damage, four (27%) had subclinical hepatic injury, five (33%) manifested varying degrees of hepatocellular necrosis and cholestasis, and four (27%) had fulminant hepatic failure. Jaundice was not associated with mortality (p > 0.05), but it appeared to predict the length of hospital confinement. Early elevations in transaminase and alkaline phosphatase, a more than tenfold increase in alanine aminotransferase, and a severe derangement in prothrombin time all indicate poor prognosis. Metabolic acidosis and hypoglycemia were significantly associated with mortality (p < 0.01 and p < 0.05, respectively). The use of intravenous N-acetylcysteine did not significantly alter disease outcome (p > 0.05). Our mortality rate was 27%, confirming that yellow phosphorus is extremely lethal when ingested. Its indiscriminate use in the manufacture of fireworks should be eliminated.

MeSH terms

  • Acetylcysteine / therapeutic use
  • Acute Disease
  • Adult
  • Alanine Transaminase / blood
  • Aspartate Aminotransferases / blood
  • Chemical and Drug Induced Liver Injury / blood
  • Chemical and Drug Induced Liver Injury / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Phosphorus / poisoning*
  • Prothrombin Time


  • Phosphorus
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Acetylcysteine