Intravascular hemolysis in phenol poisoning: An unforeseen and rare complication

Abstract

The black phenyl is a powerful germ killer used for homes, hospitals, which is easily accessible and can be consumed with the intention of self harm. Cases of intravascular hemolysis through inhalation or spillage has been reported, but intravascular hemolysis following ingestion is rarely reported. A 25 year old previously healthy male presented after alleged ingestion of black phenyl and was asymptomatic at presentation. By day 4, he developed fever, icterus, tachycardia, fatigue and dark brown urine. Labs were Hgb 3.6g/dl, platelet count 2.75 lakhs/ul, creatinine 1.1mg/ dI, AST 244U/L, ALT 69U/L, Total Bilirubin 4.65g/dl (Indirect 3.35) PT 14.6, INR 1.23. By Day 6, urine color darkened, suggestive of ongoing hemolysis with LDH level of 3614 U/L. Over the full hospital stay, urine output was maintained, and he didn't develop acute kidney injury. By Day 9, patient's symptoms improved & he was discharged on day 12. These compounds interfere with oxidative phosphorylation in cells, making red blood cells losing osmotic equilibrium. This metabolic handicap may lead to premature red blood cell lysis. Though asymptomatic at presentation, patient developed serious intravascular hemolysis and hemoglobinuria by day 4. This suggests the need for admission of asymptomatic patients, constant monitoring and to anticipate toxic potentials of the compound. The dearth of enough literature on this rare complication made us report this first case from North East India.