Lau Fei Lung, FRCP(Edin), FHKCEM, FHKAM(Emergency Medicine)We report a 29-year-old lady who developed confusion, agitation and seizure after the ingestion of a selfmixture of 3 grams of lidocaine with antacid for treatment of dyspepsia. She developed two episodes of seizure requiring diazepam, propofol and intubation .There was no significant cardiac toxicity and she was discharged on day 3. This is the first reported adult case of seizure in the literature after intentional ingestion of lidocaine for treatment of dyspepsia. The use of local anaesthetic in gastrointestinal cocktail for dyspepsia and its safety are highlighted. Advances in the management of local anaesthetic overdose are also discussed. (Hong Kong j.emerg.med. 2009;16:41-45) 29 3

A case of severe organophosphate poisoning in a woman who ingested malathion is presented. Pralidoxime was given for more than two weeks but the lady had a poor response and developed recurrent episodes of cholinergic symptoms. Further studies are required to validate the World Health Organization regimen of pralidoxime in organophosphate poisoning.