Rodenticide poisoning in children: A study of clinical profile and electrocardiographic changes

Objectives: To study the clinical profile and electrocardiographic (ECG) changes in rodenticide poisoning in children. Methods: Patients admitted with a history of ingestion of rat poison between October 2014 and October 2016 were included in the study. Clinical history was taken in detail, and stomach wash samples were sent for toxicological analysis. Continuous ECG monitoring was done in all cases. Investigations to assess organ functions and coagulation profile were done at admission and repeated as indicated. Results: There were 17 cases of rodenticide poisoning. Zinc phosphide was the rodenticide identified in 50% of cases, bromodiolone in 30%, and yellow phosphorous in 20% cases. Only 23% presented within 1 h of ingestion and only 12% received stomach wash from referring hospital. Out of the 17 cases, 12 cases (70%) were symptomatic, of which 42% hadminor symptoms such as vomiting and abdominal pain and 58% had major symptoms including dysrhythmias, shock, coagulation abnormality, hepatic failure, and seizures. ECG changes were observed in 7 cases (42%), and coagulopathy was seen in 2 (12%) cases of which one had hepatic failure. The mean time of onset of ECG changes was 19.7 h (range 9-36 h). The overall mortality rate was 17.6%. Cardiac arrhythmia was the most common cause of death (66%). Conclusion: Zinc phosphide has been detected as the most common chemical being used as domestic rodenticide. Transient rate abnormalities, metabolic acidosis, fever, and leukocytosis are early markers of toxicity and they should be looked for in all cases. General public, medical, and aramedicalpersonnel should be made aware of the toxic nature of rodenticides

Toxic epidermal necrolysis: A study of clinical profile and treatment outcome in children

Objectives: The objective of this study is to study the clinical and laboratory profile, risk factors for the development of blood culture positive septicemia and treatment outcome of children admitted with toxic epidermal necrolysis (TEN). Methods: All children admitted with TEN from January 2012 to January 2017 were included in the study. Blood culture, organ functions, and serum electrolytes were sent at admission and repeated as clinically indicated. Children were managed with reverse isolation in workforce limited setting of a Government Medical College Hospital. Outcome measure analyzed were the duration of hospital stay, development of blood culture positive septicemia and death. Children were followed up for a variable period from 2-month to 1-year. Results: A total of 13 children were admitted with TEN in the 5-year study period, aged 7.9±3.2 years. Mean area of skin involvement was 69±19.9%. Drugs were found to be the most common cause of TEN accounting for 12 cases (92%). Evidence of renal injury was seen in 6 cases (46%). Disorders of sodium balance were the most common electrolyte abnormality observed in 11 cases (85%). There was no statistically significant difference in duration of progression of skin lesions in children who received ≥2 g/kg of intravenous immunoglobulin (IVIG) and those who received <2 g/kg of IVIG. The mortality rate was 7.6%. At follow-up, all patients had dyspigmentation and none had scarring. 6 children (46%) had ophthalmic complaints at follow-up. Conclusion: Non-steroidal anti-inflammatory drugs were found to be the most common cause of TEN in children. Furthermore, TEN was found to be a disease causing critical kidney disease in children. Multi-organ dysfunction, hyperglycemia, and need for invasive ventilation were found to be associated with increased risk of developing culture positive sepsis. Low-dose IVIG, parenteral steroids and skin care with normal saline washes and sterile liquid paraffin impregnated gauze are the effective and safe treatment options for children with TEN in resource-limited setting