Case Definition: Phosphorus, Elemental, White or Yellow
Ingestion of elemental white or yellow phosphorus typically causes severe vomiting and diarrhea, which are both described as “smoking,” “luminescent,” and having a garlic-like odor. Other signs and symptoms of severe poisoning might include dysrhythmias, coma, hypotension, and death. Contact with skin might cause severe burns within minutes to hours (1-4).
Laboratory criteria for diagnosis
- Biologic: No specific test for elemental white or yellow phosphorus is available; however, an elevated serum phosphate level might indicate that an exposure has occurred. Although phosphate production is a by-product of elemental phosphorus metabolism in humans, a normal phosphate concentration does not rule out an elemental phosphorus exposure.
- Environmental: Detection of elemental phosphorus in environmental samples, as determined by NIOSH, and an elevated phosphorus level in food, as determined by FDA, might also indicate that an exposure has occurred.
- Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
- Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for elemental white or yellow phosphorus exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
- Confirmed: A clinically compatible case in which laboratory tests on environmental samples are confirmatory.
The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or a 100% certainty of the etiology of the agent is known.
- Agency for Toxic Substances and Disease Registry. Toxicological profile for white phosphorus. Atlanta, GA: Agency for Toxic Substances and Disease Registry, Division of Toxicology; 2001.
- Harbison RD. Phosphorus. In: Harbison RD, ed. Hamilton and Hardy’s industrial toxicology. 5th ed. St Louis, MO: Mosby-Year Book; 1998:194-7.
- Simon FA, Pickering LK. Acute yellow phosphorus poisoning: smoking stool syndrome. JAMA 1976;235:1343-66.
- Talley RC, Linhart JW, Trevino AJ, Moore L, Beller BM. Acute elemental phosphorus poisoning in man: cardiovascular toxicity. Am Heart J 1972;84:139-40.