Indoxacarb Toxicity: Treat the Patient, Not the Monitor

Abstract

The arterial line was secured for hemodynamic monitoring. A short history of recurrent jaundice, easy fatiguability, passing frequent dark urine, and psychiatric medication intake was elicited, which yielded a negative response. This helped us to rule out any associated glucose-6-phosphate dehydrogenase deficiency (G-6-PDD) before initiating the antidote MB. A bolus of 100 mg MB was given intravenously over 10 minutes, following which her SpO 2 levels increased to 98% in 15 minutes. The repeat ABG on room air showed-pH-7.35, PaO 2 -85.3, PaCO 2 -27.7, HCO 3 -015.1, Na/K-0145.5/3.19 MetHb-1.9 %, O 2 Hb-94, and lactate-0.38 (Table 1). Subsequently, MB continued at 50 mg twice daily, and vitamin C was converted to an oral tablet of 500 mg thrice daily. ABG was done twice daily, and lab investigations were repeated in the AICU. Her laboratory value was mostly unremarkable except for the slight rise of creatinine from 0.86 to 0.93. Vitamin C was continued, but MB was stopped on day 3 after a psychiatric evaluation was done. She was shifted to the ward with stable vitals and advised to monitor the kidney function test and urine output.