One page note of phosphorous poisoning include everything from form to treatment
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PHOSPHORUS POISONING - One Page Note
Sources: The Essentials of Forensic Medicine & Toxicology 36th Ed (2026); Parikh's Textbook of Medical Jurisprudence; P.C. Dikshit Textbook of Forensic Medicine & Toxicology
FORMS OF PHOSPHORUS
| Feature | White (Yellow) Phosphorus | Red Phosphorus |
|---|---|---|
| Appearance | Translucent, waxy cylinders | Amorphous, solid mass |
| Smell/Taste | Garlicky | Odourless/tasteless |
| Luminosity | Luminous in dark | Non-luminous |
| Air exposure | Oxidises, emits white fumes; ignites at 34°C; kept under water | Non-oxidising, non-fuming, non-flammable |
| Uses | Fertilizers, insecticides, rodenticides, rat poison, fireworks, incendiary bombs, smoke screens, gunpowder | Sides of matchboxes |
| Toxicity | Highly toxic | Non-toxic |
MECHANISM OF ACTION
Phosphorus is a protoplasmic poison - affects cellular oxidation, comparable to ischaemia. Cellular metabolism diminishes under anoxic conditions = necrobiosis (classically in liver). Inhibits glycogen deposition in liver while increasing fat deposition. Has direct cardiotoxic and vasotoxic effects.
FATAL DOSE & PERIOD
- Fatal dose: 60-120 mg (yellow/white phosphorus)
- Fatal period: 2-8 days (collapse within 24 hrs in fulminating cases; usually 6-7 days)
SIGNS & SYMPTOMS
Fulminating Poisoning (>1 g ingested)
Death within 12 hours due to direct cardiac action and cardiovascular collapse. Restlessness, delirium, intense thirst, severe nausea, vomiting.
Acute Poisoning - Three Stages
Stage I (Hours to 1-2 days) - Local Irritation:
- Garlic-like taste in mouth; garlic odour in breath
- Burning pain: mouth → throat → oesophagus → stomach → abdomen
- Intense unquenchable thirst; gaseous eructations
- Copious vomiting - luminous in the dark, garlicky odour, bile-stained/blood-tinged
- Diarrhoea - dark, offensive, phosphorescent stools
- Abdominal tenderness and distension; hypoglycaemia
- Cardiac and respiratory depression; cold clammy skin; hypothermia
- Delirium → convulsions → collapse → coma (death if severe, 12-24 hrs)
- Skin contact: slow-healing 2nd/3rd degree burns
Stage II (2-4 days) - Apparent Recovery:
- Stage of remission - symptoms reduce in intensity
- Mild abdominal pain, occasional vomiting, malaise, headache
Stage III (Systemic Toxicity):
- Vomiting and diarrhoea return, more intense, contains mucus and blood
- Jaundice sets in rapidly; liver enlarged, soft, tender
- Haemorrhages: epistaxis, haematemesis, haematuria, melaena, menorrhagia, petechiae
- Urine: scanty, high-coloured, contains blood, albumin, bile, casts, free fat globules, amino acids (leucine, tyrosine, cysteine), lactic acid
- CNS: headache, insomnia, tinnitus, vertigo, impaired vision, formication, cramps, paralysis
- Priapism (frequent)
- Pregnant women: abortion with flooding
- Progressive hepatic and renal failure → hypoglycaemia, pulmonary oedema, cyanosis, oliguria/anuria → death
CHRONIC POISONING ("Phossy Jaw")
Seen in workers in firework/ammunition/matchbox factories (inhalation of white phosphorus fumes).
Symptoms: Nausea, vomiting, garlic-smelling eructations; generalised wasting, lassitude, emaciation, joint pain; anaemia, jaundice; tracheitis, bronchitis.
"Phossy Jaw" (pathognomonic): Osteomyelitis + periostitis of jaw. Begins with toothache → jaw swelling → loosening and falling of teeth → sloughing of gums → necrosis and sequestration of mandible (lower jaw mainly) → multiple foul-smelling pus-discharging sinuses. Phosphorus enters through carious teeth or gaps from missing teeth.
TREATMENT
Acute Poisoning
| Step | Action |
|---|---|
| Gastric lavage | 0.5% (1:5000) potassium permanganate - oxidises phosphorus to harmless phosphoric acid and phosphates; repeat till no garlic odour perceptible |
| Alternative lavage | 0.1-0.2% copper sulphate solution; OR 2% hydrogen peroxide |
| Emesis induction | 200-250 mg copper sulphate every 5 min until vomiting occurs |
| Bowel evacuation | Magnesium sulphate (sodium sulphate) purgative; repeat bowel washes |
| Adsorbent | Activated charcoal |
| Retard absorption | Liquid paraffin (NOT castor oil) |
| CONTRAINDICATED | Oils, fats, milk - dissolve phosphorus and promote absorption |
| Liver protection | High carbohydrate, low protein/fat diet; IV dextrose/glucose; alkaline drinks; multivitamins |
| Shock/dehydration | IV glucose-saline (500 mL of 5%); IV calcium gluconate 10 mL of 10%; sodium bicarbonate to maintain alkali reserve; noradrenaline; plasma |
| Haemorrhage | Vitamin K 20 mg IV (repeat doses) for hypoprothrobinaemia; blood transfusion |
| Renal failure | Peritoneal dialysis or haemodialysis |
| Skin burns | Irrigate with 1% copper sulphate solution for ≥10 minutes |
Chronic Poisoning (Prophylaxis + Treatment)
- Factory hygiene: cleanliness, ventilation, oral hygiene (mouth wash with sodium bicarbonate)
- Regular dental care - extract/fill carious teeth
- Surgical intervention if mandibular necrosis occurs
POSTMORTEM APPEARANCES
Death within 24 hours:
- Slight icteric tinge
- Mucous membranes of pharynx, oesophagus, stomach, intestines: inflamed, reddened, ulcerated, corroded
- Stomach contents: contracted, yellowish-green, luminous in dark, garlicky odour
Death after 24-48 hours:
- Jaundice; garlicky body odour
- Petechial haemorrhages under skin, serous/submucous surfaces of lungs, brain, leptomeninges, uterus, kidneys
- Liver: enlarged, lemon-yellow, doughy, soft, greasy, friable; fatty degeneration + cellular necrosis + Kupffer cell fat accumulation (earliest sign of necrobiosis); haemorrhagic spots on Glisson's capsule
- Heart: soft, flabby, dilated; fatty degeneration; subendocardial haemorrhages (left ventricle)
- Kidneys: enlarged, soft, greasy, yellow; petechial haemorrhages; fatty degeneration; cellular debris and fatty casts
- Blood: tarry appearance; diminished coagulability
Liver in Phosphorus Poisoning vs. Acute Yellow Atrophy
| Feature | Phosphorus Poisoning (Necrobiosis) | Acute Yellow Atrophy |
|---|---|---|
| Size | Enlarged at first, later normal or contracted | Smaller, wrinkled capsule |
| Colour | Uniformly yellow (marbled) | Dirty/bright yellow early; deep red later |
| Consistency | Soft, greasy, friable | Leathery/very soft and flabby |
| Structure | Fatty degeneration + some cellular necrosis + haemorrhages | Necrosis of most cells; connective tissue intact |
| Stage | Early | Late (survivor >1 week) |
CHEMICAL ANALYSIS (Medicolegal)
- Preservation of viscera: Saturated solution of common salt (NOT rectified spirit - luminosity is lost in spirit)
- Significance: Detection of phosphates alone has no medicolegal value (phosphates occur normally in the body). Only detection of free (elementary) phosphorus is significant.
- Phosphorus can be detected in an unoxidised form in dead bodies even in an advanced state of decomposition (reducing gases produced during decomposition protect phosphorus from oxidation).
- Gettler's test: Done for phosphorus poisoning (the body fluids/vomit glow in the dark - luminescence).
MEDICOLEGAL ASPECTS
| Aspect | Details |
|---|---|
| Accidental | Children eating firecrackers or rat pastes; industrial workers (chronic) |
| Suicidal | Rat poison pastes (zinc phosphide, aluminium phosphide) ingested |
| Homicidal | Rat poison mixed in strong sweet tea/coffee to disguise taste/smell - used as homicidal poison because (a) symptoms mimic acute liver disease, and (b) death delayed by several days |
| Incendiary | Phosphorus in moist paper/wet cloth/dung used to set fire to property |
| Detectability | Detectable even in putrefied bodies; finding in free form is proof of poisoning |
References: The Essentials of Forensic Medicine & Toxicology 36th Ed (2026), p.521-525 | Parikh's Textbook of Medical Jurisprudence, p.589-591 | P.C. Dikshit Textbook of Forensic Medicine & Toxicology, p.502-506
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