Rare case of ammonium Dichromate Poisoning in a kid reported

Medically Reviewed By : Dr. Kamal Kant Kohli

Published On 2020-12-17 05:06 GMT | Update On 2020-12-17 08:59 GMT

Himanshu Kumar and colleagues from the Department of Pediatrics, King George's Medical University, Lucknow, India recently reported an interesting case of ammonium Dichromate Poisoning.

The study is published in the Indian Journal of Pediatrics.

Chromium (Cr) is a strong oxidant and poisoning usually begins with gastrointestinal symptoms progressing to multiorgan failure. A lethal dose of chromium salt varies between 6 to 8 g in adults and 1 g in children. In the human body, Cr VI is reduced to Cr III, a non-toxic form, in the plasma but when the reducing capacity is saturated, Cr VI enters the cell and causes damage by lipid peroxidation and enzyme inhibition.

Shortly after oral ingestion of chromates gastrointestinal mucosa is damaged, manifesting as rice-water stools, emesis, and corrosive burns of the mouth and esophagus. Systemic absorption in large doses, lead to shock with multiorgan failure especially hepato-renal involvement

The authors studied the case of a 2-year-old boy who presented with a history of multiple episodes of vomiting, copious mucoid loose stools, and sluggishness after one hour of ingestion of an unknown amount of an orange-colored crystal-like substance kept at home for father's printing work. On examination, the child was lethargic, had severe dehydration and hypovolemic shock.

Ringer lactate infusion was started immediately, and gastric lavage was done with normal saline. The substance which child had consumed was found to be ammonium dichromate. So, a high dose of vitamin C (500 mg/d, oral) and N- acetylcysteine (NAC; 150 mg/kg intravenously) were administered on day 1 only.

Blood chromate level was sent at Indian Institute of Toxicology and Research (IITR), Lucknow and results on day 3 showed chromate level- 71.96 mcg/L which was higher than the normal chromate of 0.1–0.16 mcg/L. The child improved with treatment and the vomiting and diarrhea also subsided at the end of day 1. He was discharged after 4 d of hospital stay, described Kumar.

Hence, the authors further discussed that various treatment modalities have been tried in acute dichromate poisoning including antioxidants, chelating agents, peritoneal or hemodialysis and exchange transfusion. However, the management of shock and dehydration is crucial especially in the pediatric population.

NAC can increase the excretion of chromium whereas ascorbic acid in large doses accelerates the rate of reduction of chromium VI to chromium III. Although poisoning due to chromium is mostly fatal, early treatment can save a patient's life, they explained.

Article Source : The Indian Journal of Pediatrics

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Dr. Nandita Mohan

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

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Rare case of ammonium Dichromate Poisoning in a kid reported

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