Complications and management of acute copper sulphate poisoning; a case discussion

Champika Ssk Gamakaranage,Ariaranee Gnanathasan,Chaturaka Rodrigo,Visvalingam Puvanaraj,Harshani Fernando,Sajitha Weerasinghe

doi:10.1186/1745-6673-6-34

Champika Ssk Gamakaranage, Ariaranee Gnanathasan + Show 4 more

Open Access

https://doi.org/10.1186/1745-6673-6-34

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Abstract

Copper sulphate ingestion (accidental or deliberate) is a rare form of poisoning usually limited to the Indian subcontinent. Though the rates are on the decline, it is essential that physicians are aware of its lethal complications and management strategies. The main complications of copper sulphate ingestion include intravascular haemolysis, methaemoglobinaemia, acute kidney injury and rhabdomyolysis. The lethal dose can be as small as 10 grams. We have explored the complications of acute copper sulphate poisoning with examples from two case presentations. We also recommend measures for prevention of such events.

Highlights

Copper sulphate is an accessible chemical in Sri Lanka that is sold over the counter
We suggest that serum amylase level should be monitored carefully in patients with copper sulphate poisoning and the possibility of acute pancreatitis must be considered though it may be difficult to confirm it by imaging due to concurrent renal failure
Ingestion of copper sulphate is a rare form of poisoning

Summary

Introduction

Copper sulphate is an accessible chemical in Sri Lanka that is sold over the counter. Case presentation 1 A 26 year old male was admitted following ingestion of approximately 30 grams of copper sulphate 48 hours prior to admission He had been managed initially at the local hospital for 2 days, with penicillamine (500 mg 6 hourly) and symptomatic treatment. The hepatitis was managed symptomatically and the liver enzyme levels were not markedly altered His abdominal pain and clinical features resembled acute pancreatitis (epigastric pain radiating to back, lack of hard abdominal signs despite severe pain) and interestingly the serum amylase level was very high. Case presentation 2 A 45 year old, previously healthy man was admitted two hours after ingestion of approximately 50 grams of highly concentrated copper sulphate, in a suicidal attempt After ingestion, he had vomited bluish gastric contents and later complained of body weakness and abdominal pain. He did not develop any further complications on follow up

Discussion

Conclusions