Poisons, Pesticides Causing Acute Liver Failure: Experts

Hyderabad: Cases of acute liver failure from deliberate ingestion of household poisons and pesticides require urgent attention, particularly among young adults, said Dr Golamari Srinivas Reddy, consultant clinical and transplant hepatologist, at a medical conference on liver diseases in the city on Saturday.

Dr Reddy said he has treated 46 cases of rat poisoning over the past two years. “Many patients are students or newly married women. Some ingest poison out of exam fear or family pressure, others in moments of distress. Rat poison is taken in paste form and patients appear normal for a few days, but by the fifth or sixth day develop jaundice, brain complications or bleeding,” he explained.

If patients come within a week, plasma exchange therapy can flush out toxins. “Around 80–85 per cent recover fully with normal liver function. But after 10 days, survival chances drop sharply. Some need transplants and a few do not survive despite treatment,” he said.

The risk is even higher with paraquat, a pesticide widely used by farmers. “Paraquat poisoning is almost always fatal if treatment is delayed beyond 12 hours. One patient who came within four hours survived with dialysis and hemofiltration, but another who arrived after 24 hours could not be saved. Once organ damage sets in, it cannot be reversed,” he warned.

Experts also highlighted how transplants are saving patients once considered untreatable. Dr Arvinder Singh Soin, chairman, Institute of Liver Transplant and Regenerative Medicine at Medanta, Gurugram, said old assumptions on eligibility are changing.

“Traditionally, patients with cancers outside the liver were excluded, as immunosuppression was thought to accelerate recurrence. Drawing on our experience of more than 5,000 liver transplants—the largest in India—we challenged this. We studied 20 patients with other cancers at the time of evaluation. Five had treated blood cancers, 15 had active cancers in other organs treated alongside the transplant. They achieved nearly 90 per cent long-term survival,” he said.

Focusing on paediatric cases, Dr Sumana Kolar Ramachandra, senior consultant in liver transplant and HPB surgery at AIG Hospitals, stressed awareness. “In children, the most common indications are biliary atresia and Wilson’s disease. But referral must be early, before severe malnutrition or brain involvement. With timely intervention, outcomes are excellent and children can live normal lives,” she said.

She also warned against ignoring prevention. “NASH (non-alcoholic steatohepatitis) is now very common, often combined with alcohol use. Even obese children may have fatty liver disease, and if such a child contracts hepatitis A, the outcome is far worse. Lifestyle changes are critical—we cannot blindly rely on weight-loss drugs. Among women, alcoholic liver disease is rising. The same alcohol quantity that a man consumes can cause cirrhosis much earlier in a woman. After menopause, women lose hormonal protection and become equally prone to NAFLD. They also develop muscle loss earlier, worsening outcomes. These gender-specific factors must be recognised as liver disease is no longer a predominantly male problem,” she said.

Dr Mettu Srinivas Reddy, director and senior consultant of liver transplantation and HPB surgery, said India is now performing some of the world’s highest transplant numbers. “Last year, we did nearly 4,000 transplants. Patients once considered too sick—such as those with combined liver and kidney failure or fungal infections—are now surviving and returning to normal life. But we need stronger regulation and transparent allocation. The sickest must get priority, not the one with better access. Unless allocation is seen as fair, public trust will suffer,” he cautioned.