We report a case of a young man who allegedly consumed 100 mL of an indigenous pesticide which is used for the killing of rats in households in India. The constituents were azadirachtin oil (40%), tea oil (15%), pine oil (25%) and kerosene oil (20%). He presented to us with shortness of breath and altered sensorium and was found to have fMetHb (fraction of methaemoglobin) level of 80%, which has been postulated to have a fatal outcome. He responded to a low dose of methylene blue along with intravenous vitamin C and the level of fMetHb came down to 20% within 1 hour. His sensorium improved markedly with a decrease in fMetHb to non-toxic levels and he was discharged 5 days after admission. A literature review pertaining to these constituents individually or in combination causing methaemoglobinaemia is discussed in the context of this case.
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Contributors All the four authors contributed to the clinical care of the patient. KG: junior resident in charge. MJ: senior resident in charge. RSJ: assistant professor in charge. RS: professor in charge. All the four authors contributed to the writing of the paper. KG: conceptualised and wrote the first draft. MJ and RSJ: contributed to revisions. RS: contributed to conceptual design, revisions and finalisation of paper.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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