A fatal case of acute copper sulphate poisoning presenting with methaemoglobinemia and intravascular haemolysis: a case report

Abstract

Copper sulphate is a common industrial chemical that is rarely used for suicide. Ingestion of more than one gram of copper sulphate causes features of toxicity, mainly severe gastrointestinal tract erosions, methaemoglobinemia, acute kidney injury, intravascular haemolysis, and acute hepatitis. A dose of more than 10g is lethal. The management is mainly supportive. Copper chelation with penicillamine, edetate calcium disodium (EDTA) and British anti-Lewisite (BAL) can be used to minimize the toxicity. Exchange transfusion for severe methemoglobinemia has been attempted with variable success.We report a lethal case of poisoning with 75g of copper sulphate resulting in severe methaemoglobinemia, intravascular haemolysis, gastrointestinal bleeding and multi-organ failure. Exchange transfusion was carried out without success and the patient succumbed to death on the third day of the poisoning. Though it is rare, the fatality of copper sulphate poisoning necessitates proper knowledge about manifestations and management options.