Abstract
Copper sulfate is a fungicide used for the control of bacterial and fungal diseases of vegetables, fruits, and grain products. Even a very small quantity is toxic. Its acute toxicity leads to hemolytic anemia, acute tubular necrosis, hepatotoxicity, and rhabdmyolysis. A 55 year old man was hospitalized with nausea, vomiting and epigastric pain. We found hemolytic anemia, acute renal failure, hepatotoxicity (only an increase in AST) and rhabdomyolysis as a consequence of oral copper sulfate intake for suicidal purposes. The amount of urine was 3-4 L/day. D-penicillamine (900 mg/day) was started. Metabolic acidosis was recorded. Hemodialysis was performed 9 times in twenty days. Increased copper levels in serum and urine and methemoglobinemia levels decreased gradually (210 μg/dl→92 μg/dl, 98 μg/24 hour→62 μg/24 hours, 2.1%→1.6%, in the order given). Uric acid, phosphorus and bicarbonate levels were at normal levels in the urine. Anemia started to decrease on the 15th day of hemolysis and it recovered on day 30. Since nitrogen retention did not regress at the end of week three, renal biopsy was performed. Acute tubular necrosis was detected in the biopsy. The renal functions returned to normal levels on day 30. As result although renal function is normal, hemodialysis treatment together with chelating agent should be performed at an early stage in such patients.
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