title: Blue vitriol poisoning: a 10-year experience in a tertiary care hospital.
abstract: OBJECTIVE
  Copper sulphate poisoning, while unusual in the West, is not rare in the Indian subcontinent, and mostly suicidal in intent. Unfortunately, data available on copper sulphate poisoning is limited. This study was planned to identify common presentations and complications of copper sulphate poisoning, and biochemical parameters that predict outcomes in these patients.
  
  
  METHODS
  A retrospective analysis of 35 patients presenting with copper sulphate poisoning over a period of 10 years (2001-2010) was performed, based on review of their medical records. Paediatric cases and patients with concomitant poisoning with other substances were excluded. Clinical presentation, laboratory parameters, complications and treatment modalities were studied.
  
  
  RESULTS
  Of the 35 cases, 23 were females (65.71%). Mean age was 29.18 ± 10.77 years. Vomiting was the commonest symptom (85.71%) followed by diarrhoea (45.71%), epigastric pain (42.86%) and rectal passage of blood (31.43%). Fourteen (40%) patients had pre-existing psychiatric disease. Medical signs included pallor (37.14%) and icterus (37.14%). Major complications included hemolysis (68.57%), renal failure (51.43%), acute hepatitis (45.71%) and upper gastrointestinal bleed (40%). Mean serum copper at presentation was 104.53 ± 56.67 μg/dL; mean methemoglobin level was 9.59 ± 8.28%. Twenty-seven patients survived yielding a mortality rate of 22.9%. Peak serum aspartate and alanine aminotransferases were significantly lower (223.8 ± 247.3 U/L, 66.3 ± 92.2 U/L) in survivors compared to non-survivors (489.6 ± 374.0 U/L, 192.9 ± 168.7 U/L; p = 0.03, p < 0.01, respectively). Analysis by receiver operating characteristic (ROC) curve showed sensitivities of 100% and 85.7%, and specificities of 73.1% and 69.2%, respectively for peak serum alanine aminotransferase levels greater than 55 U/L, and peak serum aspartate aminotransferase levels greater than 234 U/L in predicting mortality.
  
  
  CONCLUSIONS
  Copper sulphate is a potent poison that can involve multiple organ systems. Elevated levels of serum aspartate and alanine aminotransferases beyond the aforementioned values can identify patients at greater risk of mortality, allowing for institution of aggressive treatment.
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India.
authors.forename: Kushal
authors.initials: K
authors.lastname: Naha
authors.forename: Kavitha
authors.initials: K
authors.lastname: Saravu
authors.forename: Barkur Ananthakrishna
authors.initials: BA
authors.lastname: Shastry
mesh_terms: D000328:Adult; D000931:Antidotes / Q000506:poisoning*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000401:mortality / Q000473:pathology; D019327:Copper Sulfate / Q000506:poisoning*; D005260:Female; D006461:Hemolysis; D006801:Humans; D007194:India / Q000453:epidemiology; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D011041:Poisoning / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000931:Antidotes; D019327:Copper Sulfate