Intensive Medical Ward (IMCW), Stanley Medical College, Chennai, Tamilnadu
To compare two protocols of management in acute copper sulphate (CuSo4) poisoning. Protocol I is traditional (aggressive management) with gastric lavage, forced alkaline diuresis (FAD) and D-penicillamine, while Protocol II (non-aggressive management) avoids gastric lavage and FAD, and treatment essentially involves administration of demulcent along with adequate intravenous fluids and D-penicillamine.
Of the total 124 patients with acute CuSo4 poisoning, 84 were treated by Protocol I and 40 patients by Protocol II. The results of the two protocols were compared for mortality and morbidity due to gastrointestinal haemorrhage, intravascular haemolysis (IVH), anaemia, jaundice, renal failure, rhabdomyolysis, ARDS, and pancreatitis.
Patients treated under Protocol I (aggressive) had a mortality of 7.4% compared to 2.5% with Protocol II (non-aggressive) (p value 0.3). Morbidity with Protocol I revealed IVH 48.8%, jaundice 29.8%, renal failure 14.3%, G.I. Bleed 11.9%, pancreatitis 2.5% and ARDS 1.2% while with Protocol II it was jaundice 5%, anaemia 2.5% and G.I. Bleed 2.5%. Overall morbidity with Protocol I was 64.28% compared to 22.5% for Protocol II which is statistically significant (p value 0.001).
Protocol II (non-aggressive management of acute CuSo4) involving administration of demulcent, adequate IV fluids and chelating with D-penicillamine was shown to reduce morbidity and mortality significantly.
