Rattol Poisoning — Clinical Hepatology Perspective

What “Rattol” Actually Is (No Myths)

Rattol in India is most commonly a yellow phosphorus–based rodenticide.
This is not a simple poison — it is a delayed, fulminant hepatotoxin.

There is no antidote.

Mechanism of Toxicity (Why It’s Dangerous)

• Yellow phosphorus causes direct hepatocellular necrosis

• Leads to acute liver failure (ALF) ± multiorgan failure

• Toxicity is dose-dependent but unpredictable

• Early phase can look deceptively mild

➡ Patients die not on Day 1 — but Day 3–7, when liver failure declares itself.

Classical Clinical Phases

Phase 1 (0–24 hours)

• Nausea, vomiting, abdominal pain

• Often mislabeled as “gastritis” or “food poisoning”

• LFTs may still be normal

⚠️ False reassurance phase

Phase 2 (24–72 hours)

• Apparent symptomatic improvement

• Patient looks “better”

• LFTs start rising quietly

⚠️ Most dangerous phase — patients are wrongly discharged here

Phase 3 (3–7 days)

• Acute liver failure

• Jaundice, coagulopathy

• Encephalopathy

• AKI, metabolic acidosis

• High mortality

Key Hepatology Red Flags

• Rising AST/ALT (often >1000)

• Rapidly worsening INR

• Falling glucose

• Altered sensorium

• Metabolic acidosis

• Rising lactate

➡ This is transplant-level disease, not ward-level care.

Management Principles (No Nonsense)

What DOES NOT Work

• No antidote

• No charcoal beyond early window

• No herbal or “detox” therapy

• Steroids have no proven role

What MUST Be Done

• Early ICU admission

• Serial LFTs, INR, lactate, ammonia

• Aggressive supportive care

• Early referral to liver transplant center

• Do not wait for encephalopathy

👉 Timing is everything.
👉 Transplant decisions must be anticipatory, not reactive.

Prognosis

• Highly variable

• Some recover with supportive care

• Many progress rapidly to ALF

• Delayed referral = poor outcome

Once advanced encephalopathy and multiorgan failure set in, outcomes crash.

Hepatologist’s Bottom Line

Rattol poisoning is acute liver failure until proven otherwise.

If you are “observing” a patient with yellow phosphorus poisoning, you are already behind.

One-Line Expert Teaching Point

Rattol poisoning is not a toxicology problem — it is a transplant-timing problem.

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