Rare case of ammonium Dichromate Poisoning in a kid reported
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.
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