A 24-year-old female was admitted to our intensive care unit (ICU) with repeated episodes of seizures following deliberate ingestion of an unknown quantity of the anti-lice medication BUTOX (Deltmethrin 1.2%). On arrival in the emergency department, the patient was given a bolus dose of Lorazepam, and soon intubated, and then a loading dose of phenytoin was commenced. Gastric lavage was not performed as patient had repeated convulsions. On examination, she was deeply comatose, and was getting generalized tonic clonic seizures. Her pulse rate was 130/min regular, and her blood pressure was 136/76 mmHg. Her pupils were equal (2 mm in size) bilaterally briskly reacting to light. Other systemic examinations were unremarkable. An arterial blood gas showed mild metabolic acidosis. Hemogram, renal and liver function tests, electrocardiogram, and chest X-ray were normal. After repeat doses of Lorazepam and phenytoin, the patient was put on mechanical ventilatory support. A therapeutic coma was induced using a combination of Midazolam and Thiopentone sodium, as the patient continued to have convulsions. In the next 36 hours, Thiopentone and Midazolam were gradually tapered off after electroencephalography documentation of complete suppression of burst activity. She was gradually weaned off the ventilator after 72 hours. She was discharged from the hospital on Day 5 after psychiatry consultation.
A 1-year, 6-month-old boy was presented to us 8 h postexposure with burn of 20% BSA involvement including the lower part of the face and anterior chest wall. After initial resuscitation including intubation and ventilation, he was hyperhydrated assuming the possibility of acute kidney injury (AKI) secondary to pigment nephropathy, but in spite of this, his urine output started falling from day 2 of admission, and hemoglobinuria became obvious along with rising creatinine from 0.28 to 0.98 mg/dl. Furosemide infusion was started to maintain urine output >1.5 ml/kg/h, and slowly with judicious fluid support and furosemide infusion, urine started clearing from 4th day of admission and creatinine normalized. Evaluation of the gastrointestinal tract by endoscopy revealed esophagus Grade 2b and stomach Grade 2a burn injury. He was extubated by day 6 of mechanical ventilation. He was initially kept on total parenteral nutrition for 7 days and thereafter started on clear liquids which were gradually built up to semi-solid. Solids were initiated after 6 weeks, once repeat endoscopy revealed normal esophageal and gastric mucosa. At present, he is doing well without any long-term complication.\nAccording to the parents/onlookers, none of the children ingested significant amount of carbolic acid as they spitted it out immediately, and the majority of the carbolic acid was splattered on their various body parts.