Blue vitriol poisoning: A 10-year experience in a tertiary care hospital

Kushal Naha, Kavitha Saravu, Barkur Ananthakrishna Shastry

Research output: Contribution to journalArticle

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Abstract

Background and aim. Copper sulphate poisoning, while unusual in the West, is not rare in the Indian subcontinent, and mostly suicidal in intent. Unfortunately, data available on copper sulphate poisoning is limited. This study was planned to identify common presentations and complications of copper sulphate poisoning, and biochemical parameters that predict outcomes in these patients. Materials and methods. A retrospective analysis of 35 patients presenting with copper sulphate poisoning over a period of 10 years (20012010) was performed, based on review of their medical records. Paediatric cases and patients with concomitant poisoning with other substances were excluded. Clinical presentation, laboratory parameters, complications and treatment modalities were studied. Results. Of the 35 cases, 23 were females (65.71%). Mean age was 29.18±10.77 years. Vomiting was the commonest symptom (85.71%) followed by diarrhoea (45.71%), epigastric pain (42.86%) and rectal passage of blood (31.43%). Fourteen (40%) patients had pre-existing psychiatric disease. Medical signs included pallor (37.14%) and icterus (37.14%). Major complications included hemolysis (68.57%), renal failure (51.43%), acute hepatitis (45.71%) and upper gastrointestinal bleed (40%). Mean serum copper at presentation was 104.53±56.67 μg/dL; mean methemoglobin level was 9.59±8.28%. Twenty-seven patients survived yielding a mortality rate of 22.9%. Peak serum aspartate and alanine aminotransferases were significantly lower (223.8±247.3U/L, 66.3±92.2U/L) in survivors compared to non-survivors (489.6±374.0U/L, 192.9±168.7U/L; p =0.03, p <0.01, respectively). Analysis by receiver operating characteristic (ROC) curve showed sensitivities of 100% and 85.7%, and specificities of 73.1% and 69.2%, respectively for peak serum alanine aminotransferase levels greater than 55 U/L, and peak serum aspartate aminotransferase levels greater than 234 U/L in predicting mortality. Conclusion. Copper sulphate is a potent poison that can involve multiple organ systems. Elevated levels of serum aspartate and alanine aminotransferases beyond the aforementioned values can identify patients at greater risk of mortality, allowing for institution of aggressive treatment.

Original languageEnglish
Pages (from-to)197-201
Number of pages5
JournalClinical Toxicology
Volume50
Issue number3
DOIs
Publication statusPublished - 01-03-2012

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Copper Sulfate
antineoplaston A10
Tertiary Healthcare
Tertiary Care Centers
Poisoning
Aspartate Aminotransferases
Alanine Transaminase
Serum
Mortality
Methemoglobin
Pediatrics
Poisons
Pallor
Preexisting Condition Coverage
Copper
Hemolysis
Jaundice
Acute Kidney Injury
ROC Curve
Blood

All Science Journal Classification (ASJC) codes

  • Toxicology

Cite this

Naha, Kushal ; Saravu, Kavitha ; Shastry, Barkur Ananthakrishna. / Blue vitriol poisoning : A 10-year experience in a tertiary care hospital. In: Clinical Toxicology. 2012 ; Vol. 50, No. 3. pp. 197-201.
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abstract = "Background and aim. Copper sulphate poisoning, while unusual in the West, is not rare in the Indian subcontinent, and mostly suicidal in intent. Unfortunately, data available on copper sulphate poisoning is limited. This study was planned to identify common presentations and complications of copper sulphate poisoning, and biochemical parameters that predict outcomes in these patients. Materials and methods. A retrospective analysis of 35 patients presenting with copper sulphate poisoning over a period of 10 years (20012010) was performed, based on review of their medical records. Paediatric cases and patients with concomitant poisoning with other substances were excluded. Clinical presentation, laboratory parameters, complications and treatment modalities were studied. Results. Of the 35 cases, 23 were females (65.71{\%}). Mean age was 29.18±10.77 years. Vomiting was the commonest symptom (85.71{\%}) followed by diarrhoea (45.71{\%}), epigastric pain (42.86{\%}) and rectal passage of blood (31.43{\%}). Fourteen (40{\%}) patients had pre-existing psychiatric disease. Medical signs included pallor (37.14{\%}) and icterus (37.14{\%}). Major complications included hemolysis (68.57{\%}), renal failure (51.43{\%}), acute hepatitis (45.71{\%}) and upper gastrointestinal bleed (40{\%}). Mean serum copper at presentation was 104.53±56.67 μg/dL; mean methemoglobin level was 9.59±8.28{\%}. Twenty-seven patients survived yielding a mortality rate of 22.9{\%}. Peak serum aspartate and alanine aminotransferases were significantly lower (223.8±247.3U/L, 66.3±92.2U/L) in survivors compared to non-survivors (489.6±374.0U/L, 192.9±168.7U/L; p =0.03, p <0.01, respectively). Analysis by receiver operating characteristic (ROC) curve showed sensitivities of 100{\%} and 85.7{\%}, and specificities of 73.1{\%} and 69.2{\%}, respectively for peak serum alanine aminotransferase levels greater than 55 U/L, and peak serum aspartate aminotransferase levels greater than 234 U/L in predicting mortality. Conclusion. Copper sulphate is a potent poison that can involve multiple organ systems. Elevated levels of serum aspartate and alanine aminotransferases beyond the aforementioned values can identify patients at greater risk of mortality, allowing for institution of aggressive treatment.",
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Blue vitriol poisoning : A 10-year experience in a tertiary care hospital. / Naha, Kushal; Saravu, Kavitha; Shastry, Barkur Ananthakrishna.

In: Clinical Toxicology, Vol. 50, No. 3, 01.03.2012, p. 197-201.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Blue vitriol poisoning

T2 - A 10-year experience in a tertiary care hospital

AU - Naha, Kushal

AU - Saravu, Kavitha

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PY - 2012/3/1

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N2 - Background and aim. Copper sulphate poisoning, while unusual in the West, is not rare in the Indian subcontinent, and mostly suicidal in intent. Unfortunately, data available on copper sulphate poisoning is limited. This study was planned to identify common presentations and complications of copper sulphate poisoning, and biochemical parameters that predict outcomes in these patients. Materials and methods. A retrospective analysis of 35 patients presenting with copper sulphate poisoning over a period of 10 years (20012010) was performed, based on review of their medical records. Paediatric cases and patients with concomitant poisoning with other substances were excluded. Clinical presentation, laboratory parameters, complications and treatment modalities were studied. Results. Of the 35 cases, 23 were females (65.71%). Mean age was 29.18±10.77 years. Vomiting was the commonest symptom (85.71%) followed by diarrhoea (45.71%), epigastric pain (42.86%) and rectal passage of blood (31.43%). Fourteen (40%) patients had pre-existing psychiatric disease. Medical signs included pallor (37.14%) and icterus (37.14%). Major complications included hemolysis (68.57%), renal failure (51.43%), acute hepatitis (45.71%) and upper gastrointestinal bleed (40%). Mean serum copper at presentation was 104.53±56.67 μg/dL; mean methemoglobin level was 9.59±8.28%. Twenty-seven patients survived yielding a mortality rate of 22.9%. Peak serum aspartate and alanine aminotransferases were significantly lower (223.8±247.3U/L, 66.3±92.2U/L) in survivors compared to non-survivors (489.6±374.0U/L, 192.9±168.7U/L; p =0.03, p <0.01, respectively). Analysis by receiver operating characteristic (ROC) curve showed sensitivities of 100% and 85.7%, and specificities of 73.1% and 69.2%, respectively for peak serum alanine aminotransferase levels greater than 55 U/L, and peak serum aspartate aminotransferase levels greater than 234 U/L in predicting mortality. Conclusion. Copper sulphate is a potent poison that can involve multiple organ systems. Elevated levels of serum aspartate and alanine aminotransferases beyond the aforementioned values can identify patients at greater risk of mortality, allowing for institution of aggressive treatment.

AB - Background and aim. Copper sulphate poisoning, while unusual in the West, is not rare in the Indian subcontinent, and mostly suicidal in intent. Unfortunately, data available on copper sulphate poisoning is limited. This study was planned to identify common presentations and complications of copper sulphate poisoning, and biochemical parameters that predict outcomes in these patients. Materials and methods. A retrospective analysis of 35 patients presenting with copper sulphate poisoning over a period of 10 years (20012010) was performed, based on review of their medical records. Paediatric cases and patients with concomitant poisoning with other substances were excluded. Clinical presentation, laboratory parameters, complications and treatment modalities were studied. Results. Of the 35 cases, 23 were females (65.71%). Mean age was 29.18±10.77 years. Vomiting was the commonest symptom (85.71%) followed by diarrhoea (45.71%), epigastric pain (42.86%) and rectal passage of blood (31.43%). Fourteen (40%) patients had pre-existing psychiatric disease. Medical signs included pallor (37.14%) and icterus (37.14%). Major complications included hemolysis (68.57%), renal failure (51.43%), acute hepatitis (45.71%) and upper gastrointestinal bleed (40%). Mean serum copper at presentation was 104.53±56.67 μg/dL; mean methemoglobin level was 9.59±8.28%. Twenty-seven patients survived yielding a mortality rate of 22.9%. Peak serum aspartate and alanine aminotransferases were significantly lower (223.8±247.3U/L, 66.3±92.2U/L) in survivors compared to non-survivors (489.6±374.0U/L, 192.9±168.7U/L; p =0.03, p <0.01, respectively). Analysis by receiver operating characteristic (ROC) curve showed sensitivities of 100% and 85.7%, and specificities of 73.1% and 69.2%, respectively for peak serum alanine aminotransferase levels greater than 55 U/L, and peak serum aspartate aminotransferase levels greater than 234 U/L in predicting mortality. Conclusion. Copper sulphate is a potent poison that can involve multiple organ systems. Elevated levels of serum aspartate and alanine aminotransferases beyond the aforementioned values can identify patients at greater risk of mortality, allowing for institution of aggressive treatment.

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