Poisning Center - Pediatric On Call

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katiha...

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POISIONING CENTER

Drug

Treatment Details

Copper

Copper as a metal is not poisonous. Copper compounds are powerful inhibitors of enzymes.
Poisonous compounds:
1} Copper sulphate {blue vitriol} occurs in large, blue crystals.
2} Copper subacetate {verdgris or zangal} occurs in bluish green masses or powder.

Route : Ingestion, Inhalation

Fatal dose : Copper sulphate – 30 g. Copper subacetate – 15 g.

Fatal Period : 1-3 days.

Clinical picture : Symptoms appear within 30 minutes of ingestion. There is an astringent metallic taste, increased salivation, burning pain in the stomach with colicky abdominal pain, thirst, nausea, eructations and repeated vomiting. The vomited matter is blue or green. There is diarrhoea with much straining, motions are liquid and brown but not bloody. Oliguria, haematuria, albuminuria, acidosis and uraemia may occur. In severe cases haemolysis, haemoglobinuria, methaemoglobinaemia, jaundice, pancreatitis and cramps of legs or spasms and convulsions occur. The breathing is difficult, cold perspiration and severe headache occur. In some cases, paralysis of the limbs is followed by drowsiness, insensibility, coma and death due to shock. Later deaths occur due to hepatic or renal failure or both.
Acute inhalation of a large dose of copper dusts or fumes can cause upper respiratory irritation resulting in sore throat and cough. Conjunctivitis, palpebral oedema and sinus irritation may also occur. Nasal mucous membrane may show atrophy with perforation. Exposure of the skin to copper compounds may cause an irritant contact dermatitis, and severe exposure may cause a greenish-blue discolouration of the skin.

Chronic Poisoning:
It may occur in workers with the metal due to inhalation of dust or from food being contaminated with verdigris. Chronic inhalation of copper sulphate spray can cause Vineyard sprayer’s lung disease characterised by a histiocytic granulomatous lung. Chronic poisoning causes Wilson’s disease.
The symptoms consist of gradual anaemia, green line on the gums {diagnostic}, nausea, vomiting, colic, diarrhoea, malaise, peripheral neuritis, degeneration and atrophy of the muscles may occur.
The presence of copper deposits in tissues is known as chalcosis. Copper may be deposited in the cornea resulting in a pigmented ring in the deeper layers. Chronic contact with swimming pool water containing algicidal copper chemicals can cause green hair discolouration.

TEST: Ammonium hydroxide gives a greenish-blue precipitate which is soluble in excess and forms a blue solution.

Treatment : 1} Stomach wash with 1 percent solution of potassium ferrocyanide, which acts as an antidote by forming an insoluble cupric ferrocyanide. Emetics are contraindicated.
2} Demulcent drinks form an insoluble albuminate of copper.
3} Haemodialysis is useful in the early stage of poisoning.
4} Castor oil is given to remove poison from intestines.
5} Chelation with Penicillamine or EDTA or BAL.

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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

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