Acute respiratory distress syndrome resulting from inhalation of powdered copper.
BACKGROUND
Copper is an essential element. Poisoning with elemental copper is infrequent and manifestations rarely include the ones that our case presented.


METHODS
A previously healthy 2-year-old female patient unintentionally inhaled copper dust, developed respiratory failure a few hours later, and required mechanical ventilation. On hospital day three, the patient developed acute respiratory distress syndrome and was treated with high-frequency oscillatory ventilation for six days. She also developed hemolytic anemia, liver failure, oliguric renal failure, and evidence of acute tubular injury. During her stay in the intensive care unit she received inotropic support, packed red cells transfusion, and diuretics. A sample of bronchoalveolar lavage showed macrophages that stained positive for copper. Serum and urine copper concentrations were within the normal range after several days. Extubation was successfully achieved after two weeks and the patient was discharged on day 30 without sequelae. This is the first report of acute respiratory distress syndrome secondary to copper aspiration in a pediatric patient.


CONCLUSIONS
To our knowledge, this is the first case reported of acute respiratory distress syndrome secondary to elemental copper aspiration. It is important to the clinician to be aware of acute respiratory distress syndrome as a differential diagnosis to copper aspiration by treating the patient aggressively in an adequate clinical setting.
Donoso
Alejandro
A
Pediatric Intensive Care Unit, Padre Hurtado Hospital, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Cruces
Pablo
P
Camacho
Jorge
J
Ríos
Juan Carlos
JC
Paris
Enrique
E
Mieres
Juan Jose
JJ
D002675:Child, Preschool; D003300:Copper / Q000506:poisoning*; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D011208:Powders; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome
D011208:Powders; D003300:Copper