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 14-month-old girl was admitted 8 h postaccidental spillage of carbolic acid. On admission, she had acidotic breathing with a Glasgow Coma Scale of 9/15, convulsion, and blackish-blue discoloration of the skin of left thigh, trunk, and a portion of left hand involving a total of 25% of BSA. Topical glycerine was applied on the exposed parts. After 24 h of admission, she became oliguric and started passing dark brownish urine, and creatinine progressively increased from 0.11 to 3.18 mg/dl, along with the evidence of intravascular hemolysis []. Hemodialysis was initiated on day 3 of admission, but fortunately could be discontinued after four cycles as renal parameter started improving. At last 9-month follow-up, she had normal renal parameters with healing skin lesions.