A 35-year-old male was admitted to our emergency department with giddiness as the major complaint following ingestion of an unknown quantity of an unknown poison. Patient was conscious, oriented with stable cardio-respiratory parameters at the time of arrival. After sometime, despite being well oxygenated via face mask, patient started having generalized tonic-clonic seizures. Initial attention to airway, breathing and circulation (ABC) was given, followed by a bolus dose of diazepam. Seizures subsided for a brief period only to recur repeatedly.\nOn repeated enquiry, the patient's relative brought empty bottles of “ALL OUT,” a commercial composition of pyrethroid used as insecticides providing a circumstantial evidence of the nature of the poisoning.\nPatient was given a bolus dose of thiopentone sodium, and soon his trachea was intubated. This was followed by a loading dose of the anti-convulsant phenytoin to control seizures.\nPatient was shifted to the intensive care unit for further management. On examination, he was deeply comatose. There was profuse sweating. His pulse rate was 136 per minute, and the blood pressure was 90/60mmHg. His pupils were dilated bilaterally and sluggishly reacting to light. Examination of the other systems was unremarkable. Hemogram, liver and kidney function tests, X-ray chest, ECG, and arterial blood gases were normal. Patient was put on a ventilator on the SIMV mode.\nAgain the patient started showing tonic–clonic seizures, which were continuous and unresponsive to anti-convulsant therapy. Thereafter, thiopentone sodium and midazolam infusions were administered and titrated clinically as no bedside EEG monitoring was available. Gradually, thiopentone sodium and midazolam infusions were tapered off, and patient was weaned off the ventilator to be extubated after 72 hours. The patient was discharged from the hospital on the 7th day after a psychiatry consultation.
A 2-year-old girl was admitted within 2 h of accidental ingestion of carbolic acid with burn injury of about 8% of body surface area (BSA). Lips, tongue as well as part of the face, and chest were involved due to spillage, but pharynx and airway were spared. She was irritable and had drooling of saliva but no other systemic complications or airway-related issues. Glycerine was applied over the exposed skin as local therapy to prevent further absorption of carbolic acid. Initially, kept nil orally for 2 days and then started taking liquids followed by solids without any difficulty.