Poisoning

27 years old Indian male was admitted last week in the medicine ward with chief complaint of ingestion of poison. Patient consumed about 1 cup of herbicide after having a misunderstanding with his girlfriend. Immediately he felt giddy and was brought to the A/E department.He had 5 - 6 episodes vomiting, about half a cup, containing fluid and food particles. There was burning sensation in the throat as well. There was no abdomen pain, diarrhea, breathing difficulty or chest pain.In the A/E stomach wash was done and poison was confirmed to be paraquat from the container which was brought by patients relatives.I examined the patient only after 3 days of admission. His vital signs were stable, general examination was unremarkable except for some redness in the posterior pharyngeal wall.Abdomen was soft and non tender, RS cvs and cns were normal. Full blood , BUSE were normal. Liver function test showed mild elevation of ALT (47 U/l). When the BUSE was repeated the next day, there was low potassium (3.1mmol/l). Patient was given Kcl 2g stat. Following that the potassium levels stabilized. Chestxray was normal.
The inital management was Fuller's earth 300ml stat, 20 ml hourly till diarrhea, activated charcoal 50g stat then 25g 4 hourly. Iv fluids and iv ranitidine 50mg tds were also given. Results of urine paraquat only came 2 days later, which was negative. Patient was discharged 3 days later.

From this patient, i learnt about paraquat poisoning. Paraquat is found commonly in weedkiller .It is a very toxic agent which can result in death from hypoxaemia secondary to lung fibrosis in moderate to severe poisonings.With high volume ingestion, death results from multiple organ failure and cardiovascular collapse within one week of ingestion.There is no antidote for paraquat poisoning.

Originally Posted by darshni

there was low potassium (3.1mmol/l). Patient was given Kcl 2g stat. Following that the potassium levels stabilized.

1. Is that the standard method of giving Potassium?
2. What will happen if potassium is given as a stat bolus?

Oral Potassiumchloride is the method of choice for mild to moderate depletion. (Plasma K >2.5mmol/L). Oral Kcl 1-2g every 2-4 hourly until return of potassium to at least 3.5mmol/l.
Iv therapy is given in patients with severe hypokalemia (<2.5mmol/l) with ECG changes, and in patients who are not able to take orally and who are symptomatic. Fast correction of hypokalemia without monitoring blood electrolytes level will lead to hyperkalemia which can cause weakness, ascending paralysis, bradycardia, prolongation of AV conduction, complete heart block.