Prevalence and causes of Toxic hepatitis across Tamil Nadu – a retrospective hospital based study.

Background

  • In the West, Paracetamol overdose is the commonest cause of toxic hepatitis.
  • Yellow phosphorus (Rat killer Poison) is the one of the commonest cause of toxic hepatitis in Tamil Nadu- though not commonly recognised outside of southern India.
  • Documenting this will lead to increased awareness and steps to prevent / treat this problem in Tamil Nadu.                            

Objectives

  • To study the prevalence and causes of toxic hepatitis across Tamil Nadu – a retrospective hospital based study.

Study period

  • 1st January 2019 – 30th June 2019

Definition of Toxic Hepatitis

Acute hepatic dysfunction due to

  • Overdose of a drug
  • Ingestion of a toxin / poison

The degree of liver injury is to be classified into:

Acute hepatic dysfunction due to

  • Uncomplicated acute hepatitis (ie. deranged LFT, INR ≤ 1.5)
  • Acute liver injury / ALI (ie. deranged LFT and INR > 1.5)
  • Acute liver failure / ALF (ie. ALI and hepatic encephalopathy)

Inclusion Criteria

Acute hepatic dysfunction due to

  • All patients who present with toxic hepatitis due to ingestion of a toxin (ex: rat killer) or due to overdose of a drug (ex: paracetamol) are to be reported for inclusion in the study

Exclusion Criteria

  • Idiosyncratic drug induced liver injury (ie. liver injury occurring, while taking the correct dose of drug)

Expected outcome

  • Rat killer (yellow phosphorus) induced hepatotoxicity is the commonest cause of toxic hepatitis in Tamil Nadu.
  • Public health measures are needed to prevent / reduce this form of hepatotoxicity

Proforma

  • Patient initials:
  • Age:    Sex:    Village/Town:
  • Date of alleged ingestion of toxin / drug overdose
  • Type of toxin ingestion: accidental / suicidal / homicidal – If suicidal intent alleged reason for toxin ingestion:
  • Marital discord:    Exam stress:    Other::
  • Name of toxin / drug overdose:    Dose taken :
  • Underlying psychiatric illness (ex: depression):
  • Prior suicide attempt

Proforma (continued)

  • Liver function test results
  • Viral serology results, if tested for: HBsAg / HCV ab / IgM HAV / IgM HEV
  • Creatinine
  • USG abdomen – to rule out cirrhosis liver

Treatment given

  • In Emergency dept / Casualty.
  • On admission to ICU / HDU / ward: Pharmacotherapy (please mention any particular drug used to treat), plasma exchange (PLEX), liver transplant.
  • Survival at end of hospital stay :
  • Died
  • Referred to a higher centre for further treatment. (please mention name of centre so that they can be followed)
  • Discharged home well

IRB (institutional review board / ethics committee)

  • In Emergency dept / Casualty.
  • Please get IRB clearance from your respective institutions.
  • No funding or sponsors will be provided for the study.
  • Referred to a higher centre for further treatment. (please mention name of centre so that they can be followed)

Authors, in case of publication of study findings

  • 1 Author from one centre for each centre contributing 2 cases
  • Please get IRB clearance from your respective institutions.
  • 1 Author from one centre for each centre contributing 2 cases
  • 3 Authors from one centre for each centre contributing 10 or more cases
  • Order of Centre will be according to the number of cases contributed
  • Confidentiality will be maintained for all patient details
  • Institution data will also be anonymised – hence study details for example: outcomes etc – cannot be traced back to any institution.
  • Institution data will also be anonymised – hence study details for example: outcomes etc – cannot be traced back to any institution.

Contact

  • E mail id:ratkillertnisgstudy@gmail.com
  • Proforma will be soon available in TNISG website
  • Proforma and details of study will be shared in the above mentioned email also.
  • Please feel free to contact for any clarification related to the study in the above mail.
  • Last date for sending data is January 31st 2020

Contact

  • E mail id:ratkillertnisgstudy@gmail.com
  • Proforma will be soon available in TNISG website
  • Proforma and details of study will be shared in the above mentioned email also.
  • Please feel free to contact for any clarification related to the study in the above mail.
  • Last date for sending data is January 31st 2020