Incidental Aluminum Phosphide Poisoning: Case Report and Current Management

Abstract Aluminum phosphide (AlP) is a commonly used cheap rodenticide, insecticide, and fumigant. Most intoxications in the literature are suicidal ingestions, however, AlP may cause incidental inhalational toxicities as well. After ingestion or inhalation, nausea, vomiting, dyspnea and abdominal pain develops within minutes. Hallmark of toxicity is refractory hypotension, cardiac failure and severe metabolic acidosis developing within a matter of hours are the major cause of mortality. In Turkey, AlP tablets are widely accessible and are sold without any restrictions. However, there are few local case reports in the literature. Additionally, incidental AlP intoxications are rarely reported. Herein, we present a 25-year-old male patient incidentally poisoned with AlP. He was found unconscious in a grain storage unit protected by aluminum phosphide tablets. He had hypotension and tachycardia. Arterial blood gas analysis did not reveal metabolic acidosis. He was quickly intubated and admitted to Intensive Care Unit (ICU). Supportive care crystalloid solution, n-acetyl cysteine and norepinephrine infusion was administered. After 36 hours, he was extubated and discharged without any complications. There is no specific antidote or treatment for AlP toxicity. Literature is controversial regarding treatment approach. Inhalational toxicity may occur under extreme conditions, as presented in this case report. Preventive strategies should be considered to reduce incidents. Clinicians should also be aware that AlP is a widely available and highly toxic compound that has no specific antidote and toxicity needs to be urgently treated with best supportive care.

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Eucalyptus oil poisoning: two case reports

Journal of Medical Case Reports ◽

10.1186/s13256-019-2260-z ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Abraham M. Ittyachen ◽

Georgie Rajan George ◽

Meera Radhakrishnan ◽

Yetin Joy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Metabolic Acidosis ◽

Supportive Care ◽

Emergency Room ◽

Case Reports ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Eucalyptus Oil ◽

Arterial Blood

Abstract Background Eucalyptus oil poisoning is rare in adults but is not that uncommon in children. The common side effects in children include depression in the level of consciousness, ataxia, seizures, and vomiting. Unlike in children, seizures are unusual in adult patients with eucalyptus oil poisoning. We report the cases of two patients with eucalyptus oil poisoning, both adults who unintentionally took eucalyptus oil and presented to the emergency room of our institution with seizures. Case presentation Two adult Indian men who unintentionally consumed eucalyptus oil presented to the emergency room of our institution with seizures. In both patients, arterial blood gas analysis showed the presence of severe metabolic acidosis. Both the patients were managed in the intensive care unit and received standard supportive care. Metabolic acidosis was corrected with intravenous bicarbonate infusion. They were successfully discharged on the fourth day. Conclusions All physicians should be aware of the toxic effects of eucalyptus oil, which is used often in daily life in India. Supportive care in an intensive care unit, including rapid correction of metabolic acidosis and adequate maintenance of hemodynamic parameters, will lead to a rapid recovery. Warning labels should be made mandatory on all products that contain eucalyptus oil.

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P-Chloroaniline Poisoning Causing Methemoglobinemia: A Case Report and Review of the Literature

Case Reports in Emergency Medicine ◽

10.1155/2015/208732 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Anna Sarah Messmer ◽

Christian Hans Nickel ◽

Dirk Bareiss

Keyword(s):

Case Report ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Peripheral Oxygen Saturation ◽

Arterial Blood Gas ◽

Oxygen Administration ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

Common Causes ◽

Treatable Condition

Background. Methemoglobin (MetHb) most commonly results from exposure to an oxidizing chemical but may also arise from genetic, dietary, or even idiopathic etiologies.P-chloroaniline (PCA) was one of the first substances described in the context of acquired methemoglobinemia.Case Report. We report the case of a cyanotic chemistry worker who presented to our emergency department (ED) after working with PCA. His peripheral oxygen saturation (SpO2) measured by pulse oximetry was at 81% and remained on that level despite oxygen administration (100% oxygenation via nonrebreather mask). His MetHb level was measured at 42.8% in arterial blood gas analysis. After treatment with intravenous methylene blue cyanosis resolved and the patient was discharged after 36 hours of observation.Conclusion. Acquired methemoglobinemia is a treatable condition, which may cause significant morbidity and mortality. The knowledge about the most common causes, fast diagnostic, and proper treatment is crucial.

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Arterial Blood Gas Analysis of Critically Ill Corona Virus Disease 2019 Patients

Asian Journal of Research in Infectious Diseases ◽

10.9734/ajrid/2021/v6i330199 ◽

2021 ◽

pp. 51-63

Author(s):

Jitendra Lakhani ◽

Sajani Kapadia ◽

Hetal Pandya ◽

Roop Gill ◽

Rohit Chordiya ◽

...

Keyword(s):

Metabolic Acidosis ◽

Critically Ill ◽

Virus Disease ◽

Respiratory Acidosis ◽

Respiratory Alkalosis ◽

Gas Analysis ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Corona Virus

Background/Aims: The aim of present study was to find out profile and sequential pattern of Arterial Blood Gas (ABG) in critically ill Corona Virus Disease 2019 (COVID-19) patients. Study Design: Observational prospective study. Methodology: A total of 80 Reverse Transcription Polymerase Chain Reaction (RT PCR) positive cases; that needed ICU admission for their life-threatening conditions were included in this study done at teaching hospital of Gujarat, India. Non consenting patients and patients who could not be followed up as per protocol were excluded. Data of Arterial Blood Gas (ABG), performed on admission, day 5 and day 10 were taken for the analysis. Patients were followed up till they remained in ICU. Results: Of 80 patients, 3 patients had normal, 24 patients (30%) had primary disorder on ABG while 53 patients (66.25%) had mixed disorders. The most common ABG abnormality observed was respiratory alkalosis with metabolic acidosis in 16 patients (20%) while respiratory alkalosis with metabolic alkalosis in 15 patients (18.75%). There was difference in ABG pattern observed among survivors and non-survivors (P=.04); of which conspicuous was presence of “respiratory acidosis with metabolic acidosis” in 5 non-survivors (15.63%), which was not seen in survivors. Of 80 patients admitted in COVID ICU; 2 improved after day 1; 6 after day 5; 40 after day 10, making total of 48 patients surviving COVID critical condition. Of 32 non-survivors, 14 died within twenty-four hours of admission, 14 within first 5 days and 04 after 10 days of ICU stay. Conclusion: ABG done on admission and serially in severe COVID-19 patients gives useful information on underlying pathophysiology. Mixed ABG pattern was more common than single disorder which can be sign of multi-organ involvement. Respiratory acidosis with metabolic acidosis was observed significantly higher in non-survivors. Respiratory alkalosis as a part of single or mixed pattern on ABG was the most common pattern found in critically ill COVID patients.

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Clinical Effects of the Suicide Attempt with Topiramate

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2003 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S150-S150

Author(s):

G. Montero ◽

I. Alberdi ◽

L. Niell ◽

R.Á. Baena

Keyword(s):

Metabolic Acidosis ◽

Suicide Attempt ◽

Suicide Attempts ◽

Plasma Concentrations ◽

Gastric Lavage ◽

Acute Poisoning ◽

Gas Analysis ◽

Clinical Effects ◽

Arterial Blood Gas ◽

Arterial Blood

ObjectivesWe report the case of a 45-year-old male diagnosed with mixed personality disorder brought the hospital for strange behavior. He is being treated with fluoxetine, lorazepam and topiramate; and visited his psychiatrist 72 hours ago.ResultsHe has an adequate level of consciousness and describes retrograde amnesia of the last 72 hours. We found blocks of thought and abnormal behaviors such as dressing and undressing or sorting his belongings repetitively. Urine was only positive for benzodiazepines. In arterial blood gas analysis it performed highlights compensated metabolic acidosis. After ruling out neurological diseases and administrating fluids i.v. the symptoms remitted, persisting only the amnesia, establishing the diagnosis of suicide attempt with topiramate.ConclusionsThe use out-of-guidelines of topiramate in personality and eating disorders is an increasingly common habit in daily clinical practice, as well as suicide attempts with this drug. In therapeutic doses, over 40% of patients taking topiramate, have asymptomatic metabolic acidosis, which in stressful situations may have clinical relevance. In case of acute poisoning, metabolic acidosis is more frequent and severe, manifesting itself by hyperventilation, hypertension and varying degrees of impaired consciousness and cognitive functions. There is also a paradoxical increase in the frequency of seizures. Treatment is supportive and there is no antidote, being lethal cases exceptional. Gastric lavage and administration of activated charcoal have limited use. The determination of plasma concentrations of topiramate is not available for most centers and is not useful in acute poisoning.

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Equine multinodular pulmonary fibrosis (EMPF): Five case reports

Acta Veterinaria Hungarica ◽

10.1556/avet.2013.024 ◽

2013 ◽

Vol 61 (3) ◽

pp. 319-332 ◽

Cited By ~ 8

Author(s):

Bianca Schwarz ◽

Andrea Klang ◽

Barbora Bezdekova ◽

Sára Sárdi ◽

Orsolya Kutasi ◽

...

Keyword(s):

Pulmonary Fibrosis ◽

Bronchoalveolar Lavage ◽

Case Reports ◽

Clinical Signs ◽

Case Series ◽

Blood Gas Analysis ◽

Endoscopic Examination ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Arterial Blood

Equine multinodular pulmonary fibrosis (EMPF), a progressive fibrosing interstitial lung disease has been associated with gammaherpesviruses. This case series describes five horses with EMPF. Three of the horses (two in Hungary, one in the Czech Republic) were diagnosed with EMPF ante mortem. They presented with typical clinical signs of EMPF including dyspnoea and weight loss. Arterial blood gas analysis revealed hypoxaemia. Blood work showed signs of inflammation like neutrophilia and hyperfibrinogenaemia. An endoscopic examination of the respiratory tract including cytology and culture of tracheobronchial secretion and bronchoalveolar lavage were performed, revealing secondary bacterial infection in one case. A suspected diagnosis of EMPF was made on the basis of a positive EHV-5 PCR from bronchoalveolar lavage and the findings of thoracic radiographs and ultrasound examination. In one case the diagnosis was confirmed by lung biopsy. All horses died or had to be euthanised despite treatment. Two horses (from Austria) were diagnosed with EMPF post mortem. They not only had EMPF but also concurrent other diseases which seemed to be associated with immunosuppression. Three horses showed the discrete form and two horses the diffuse form of EMPF. EHV-5 DNA was identified in lung tissue of all horses by PCR.

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Blood Gas Analysis in Neonatal Tetanus

Paediatrica Indonesiana ◽

10.14238/pi34.1-2.1994.44-7 ◽

2018 ◽

Vol 34 (1-2) ◽

pp. 44-7

Author(s):

Taslim S. Soetomenggolo ◽

Dwi Putro Widodo ◽

Jimmy Passat ◽

Sofyan Ismael

Keyword(s):

Metabolic Acidosis ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Neonatal Tetanus ◽

Common Finding ◽

Blood Gas ◽

Acid Base Balance ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Significant Difference

We reviewed the results of arterial blood gas analysis in 127 patients with neonatal tetanus on admission, and in 52 of such patients on the day before they died. All patients were hospitalized at the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. On admission, most patients showed uncompensated metabolic acidosis. The mortality of patients wjth pH ofless than 7 was 100%. There was no significant difference between the mortality of patients with pH 7.35-7.45 and those with pH of less than 7.35. Analysis of acid-base balance indicated that ventilatory fw1ure was the most common finding in 52 patients who subsequently died. We recommend using intravenous fluid containing a combination of 5% dextrose and sodium bicarbonate with 4 : 1 (vol/vol) ratio from the fust day of hospitalization to reduce the possibility of the development of ongoing metabolic acidosis in patients with neonatal tetanus. Maintaining adequate ventilation is mandatory ln such patients.

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Prehospital Diagnosis of Shortness of Breath Caused by Profound Metformin-Associated Metabolic Acidosis

Healthcare ◽

10.3390/healthcare9010074 ◽

2021 ◽

Vol 9 (1) ◽

pp. 74

Author(s):

Pietro Elias Fubini ◽

Laurent Suppan

Keyword(s):

Metabolic Acidosis ◽

Hospital Setting ◽

Blood Gases ◽

Shortness Of Breath ◽

Potential Harm ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Common Causes ◽

Prehospital Diagnosis ◽

Gas Measurement

Shortness of breath is a common complaint among patients in emergency medicine. While most common causes are usually promptly identified, less frequent aetiologies might be challenging to diagnose, especially in the pre-hospital setting. We report a case of prehospital dyspnoea initially ascribed to pulmonary oedema which turned out to be the result of profound metformin-associated metabolic acidosis. This diagnosis was already made during the prehospital phase by virtue of arterial blood gas measurement. Pre-hospital measurement of arterial blood gases is therefore feasible and can improve diagnostic accuracy in the field, thus avoiding unnecessary delay and potential harm to the patient before initiating the appropriate therapeutic actions.

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