Phosphorus poisoning

　　In life, phosphorus poisoning often occurs due to accidental ingestion of phosphorus and inorganic phosphorus compounds or suicidal poisoning. Workers in phosphorus operations can be poisoned through skin contamination, large inhalation of phosphorus and its compound dust, smoke, or phosphine gas. Yellow phosphorus and phosphorus compounds are highly toxic, while red phosphorus is less toxic. Phosphorus and its compounds are mainly inhaled in the form of dust and smoke and can also be absorbed through the digestive tract and mucous membranes. After absorption, phosphorus is initially distributed in the liver, kidneys, and heart, and later mainly deposited in the liver and bones. In addition to causing severe burns and corrosion to the skin and mucous membranes, yellow phosphorus can also destroy the function of intracellular enzymes. Phosphorus poisoning mainly causes fatty degeneration of the liver, heart, kidneys, and striated muscles, demineralization of bones, vascular damage, leading to bleeding and peripheral circulatory failure.
　　After phosphorus zinc reacts with gastric acid, it produces phosphine and zinc chloride, both of which have a stimulating and corrosive effect on the gastrointestinal mucosa, causing inflammation, congestion, ulcers, and bleeding. Phosphine acts on intracellular enzymes, affecting cell metabolism and causing cellular asphyxia, leading to damage to the central nervous system, respiratory system, cardiovascular system, liver, and kidney function, with symptoms of the central nervous system appearing earliest and most prominently. Phosphorus in the body is ultimately excreted in the form of phosphates through the kidneys, with a small amount excreted through the respiratory tract and sweat glands.

　　Phosphorus poisoning often leads to peripheral neuritis, which in most cases is not due to infection or inflammation and is also known as peripheral neuropathy. The disease is caused by various reasons leading to peripheral nerve lesions (including cranial nerves and spinal nerves), manifesting as abnormal sensory, motor, and autonomic nerve function within the range of the damaged nerves. It can be either multiple or single, symmetrical or asymmetrical, and is a common disease in the nervous system.
　　If a large amount of yellow phosphorus smoke or phosphine is inhaled, patients may experience difficulty breathing within a few minutes, followed by symptoms such as pulmonary edema, which can lead to death in a short period of time.

　　Phosphorus poisoning varies in clinical manifestations depending on the type of phosphorus and the amount inhaled. Yellow phosphorus mainly enters the human body through the respiratory tract in the form of vapor and dust. Acute inhalation of phosphorus vapor can cause respiratory tract irritation and acute toxic pulmonary edema. Long-term exposure to low concentrations of yellow phosphorus primarily leads to jawbone necrosis, starting with toothache, followed by infection and suppuration, with foul-smelling exhalation. Workers exposed to刺激性 phosphorus compounds can develop obstructive lung diseases and chronic tracheitis. Yellow phosphorus can cause skin burns and, upon absorption through the skin, can cause liver damage.
　　First, acute phosphorus poisoning.
　　1. Mild poisoning:Headache, dizziness, fatigue, loss of appetite, nausea, pain in the liver area, etc., with liver enlargement and tenderness, abnormal liver function, and possible hematuria, proteinuria, and casturia.
　　2. Moderate phosphorus poisoning:The liver is significantly enlarged, tender, and the liver function is significantly abnormal or renal insufficiency, with an increase in blood urea nitrogen and plasma creatinine.
　　3. Severe poisoning:Acute liver or kidney failure.
　　Second, chronic phosphorus poisoning
　　1. Observation object:Periodontal atrophy, deepening of periodontal pockets, loose teeth, etc., with mild absorption of both sides of the alveolar ridges, showing a horizontal shape.
　　2. Mild phosphorus poisoning:After more than one year of clinical symptomatic treatment, the above symptoms show a persistent increase, with alveolar bone resorption exceeding 1/3 of the root length, periodontal ligament space widening, narrowing, or disappearing, cortical thickening, and the texture of the mandibular body becoming coarser or sparse, and arranged in disorder. There may be respiratory mucosal irritation symptoms and digestive system symptoms.
　　3. Moderate phosphorus poisoning:Symmetric bone density shadows are shown in the posterior mandibular molar area, with unclear boundaries; there may be enlargement of the mental foramen and blurred edges.
　　4. Severe poisoning:Mandibular necrosis or fistula formation.

　　Children should strengthen daily protection to prevent phosphorus poisoning. Do not let children play with matches; mark the rodent control drugs, place them next to the mouse hole at night, and remove them during the day to prevent children from picking them up and eating them by mistake; unused rodent control drugs must be properly stored; educate children not to play in places fumigated with phosphine and other substances.
　　The key to preventing phosphorus poisoning in factories is to minimize the use of yellow phosphorus as raw material, replacing it with red phosphorus or other chemical substances; pay attention to safety production, strengthen the maintenance of protective equipment and the storage of toxic substances; do a good job of personal protection; pay attention to personal hygiene, and it is best to gargle with a 5% sodium bicarbonate solution after contacting phosphorus; do not smoke or eat with contaminated hands; personnel engaged in phosphorus production should have regular physical examinations, including liver function and X-ray examination of the mandible. Those with severe oral diseases, liver and kidney diseases, blood diseases, endocrine diseases should not engage in phosphorus work.

　　Phosphorus can be detected in the vomit and feces of poisoned individuals, and it can emit phosphorescence at night or in the dark; blood tests may show a decrease in white blood cells and platelets, a decrease in blood sugar, an increase in cholesterol, bilirubin, phosphorus, calcium, a decrease in prothrombin, and an extension of bleeding and clotting time; there may be a decrease in urine output, and protein, red blood cells, and casts may appear.

　　After phosphorus poisoning, the patient's diet should be high in calories and vitamins, drink plenty of water, and also need abundant protein. Eat more fresh vegetables and fruits. Avoid spicy and fried foods such as chili, strong alcohol, fried fish, fried chicken, oil sticks, fried shrimps, and braised pork with scallion oil, as these foods will 'generate heat and fire', which is not conducive to detoxification and rejuvenation.
　　Recommended medicinal diet:Peacock and hedgehog mushroom soup
　　Ingredients:Peacock meat, hedgehog mushrooms, lean pork, Chinese yam, mung beans, lotus seeds, and one piece of dried tangerine peel.
　　Preparation method:First, blanch the peacock meat and lean pork in boiling water, then put the above ingredients together in a pot, and simmer for two hours over low heat.

　　For acute poisoning in phosphorus poisoning, the scene should be immediately left and moved to a fresh air area. Early and sufficient application of adrenal cortical hormones should be used for treatment. Fluid replacement, correction of water, electrolyte, and acid-base balance disorders. Pay attention to protect liver and kidney function in chronic phosphorus poisoning and give symptomatic treatment.
　　First, acute poisoning
　　1. After inhaling high concentrations of yellow phosphorus vapor, the scene should be immediately left and moved to a fresh air area.
　　2. After phosphorus burns the skin, it should be immediately washed thoroughly with large amounts of clean water, extinguish the phosphorus fire, thoroughly remove the embedded phosphorus particles in the tissue, and prevent the absorption of phosphorus. Washing the wound with a 2% to 3% silver nitrate solution can also achieve a good effect, and the washing should continue until there is no phosphorus fire. Avoid using oily dressings.
　　3. For oral phosphorus poisoning, give 1:5000 potassium permanganate solution for gastric lavage, children can be used up to 500mL, and adults can be used up to 1-2L. Administer activated carbon suspension, 1-2g per kilogram of body weight for adults, and 0.5-1g per kilogram of body weight for children. Paraffin oil 100-200mL for catharsis can delay the absorption of phosphorus. Avoid using salt cathartics to prevent exacerbation of gastrointestinal irritation symptoms. Phosphorus is a corrosive substance, vomiting is prohibited. Milk, high-fat foods, and other substances can increase the absorption of phosphorus, and oral poisoning should avoid their use. During the treatment process, patients and medical personnel should pay attention to protection and avoid contact with the patient's vomit, gastric lavage fluid, and feces, as they may contain phosphorus.
　　4. Supportive treatment: fluid replacement, correction of water, electrolyte, and acid-base balance disorders. Early and sufficient application of adrenal cortical hormones can protect the liver, reduce hemolysis, and be conducive to the improvement of the condition.
　　5. Other
　　(1) Patients with phosphorus poisoning caused by various routes should all monitor liver function, heart function, renal function, and coagulation mechanism, and prevent and treat damage to the heart, liver, brain, and kidneys.
　　(2) Serious patients can use blood exchange therapy.
　　(3) Early dialysis therapy should be used for patients with acute renal failure to protect renal function.
　　(4) Prevent copper poisoning when washing the stomach with copper sulfate and applying wet compresses, and do not use esterase reactivators of the oxime class.
　　Second, chronic phosphorus poisoning
　　1. Pay attention to oral hygiene, treat various oral diseases in a timely manner, and repair teeth as soon as possible.
　　2. Mandibular necrosis or osteomyelitis should be treated surgically in a timely manner.
　　3. Pay attention to protect liver and kidney function, and give symptomatic treatment.