Meulenbelt, J; Verkade, AJ; Wijnands-Kleukers, APG; De Vries, I
Acute copper sulfate intoxications have been described frequently. Many poisonings are reported from India, where copper sulfate is frequently used in suicide attempts. In the Netherlands, as in most western countries, copper sulfate poisonings are rare, although copper sulfate itself, having many agricultural, industrial and pharmaceutical applications, is readily available. However, recently the Dutch Poisons Information Centre received several requests for information regarding pediatric and teenager exposures to copper sulfate. Copper sulfate is corrosive to skin and mucous membranes. After ingestion symptoms generally occur within 15 minutes to 1 hour. Initial symptoms include abdominal pain, nausea, vomiting, diarrhea, salivation, and metallic taste, in severe cases with corrosive injury of the gastrointestinal tract leading to bleeding, perforation, hypotension, and hemolysis. Refractory shock and hepatic and renal failure with coma may develop after several days. In 2003-2004 19 cases were reported to the Dutch Poisons Centre. Six children under 4 years of age, nine teenagers and four adults were involved. The routes of exposure were ingestion (12 cases) or eye-contact (7 cases), but especially the circumstances of the exposures attracted our attention. Several young children ingested a copper sulfate containing product used as a disinfectant in farms. They either ingested granules or a solution of copper sulfate (somethimes with formaline). In a few other cases children ingested a copper sulfate solution used for algae-control in aquaria. In teenagers most intoxications occured while performing chemical experiments at school. Several girls took a sip of a copper sulfate solution, others had splashes in the eyes. Copper sulfate may also be found in children's chemistry sets and mineral gardens. In most cases only minimal symptoms occured. However serious intoxications are possible, as is illustrated by the following case reported in March 2004. In this heavy exposure case the advice of the Poisons Centre to immediately measure serum copper levels and, if indicated, start chelation therapy was neglected. A 2-year old boy ingested an unknown amount of copper sulfate (used as a disinfectant) which he found on the stable-floor. He immediately started to vomit. Upon arrival in the hospital a soporeus, pale boy was seen with a decreased saturation. Laboratory investigations revealed renal and hepatic injury and on day 3 of hospitalization he became anuric and was transferred to the Intensive Care department of another hospital for hemodialysis. Over the next week the condition of the patient improved gradually and he made a full recovery. In the Netherlands most intoxications with copper sulfate are accidental intoxications in young children in farm surroundings or in teenagers at chemistry experiments at school. It seems that copper sulfate is mistakenly considered by some people, including docters, to be a fairly harmless compound. Especially farmers and chemistry teachers should be more alert for possible risks of these compounds. In severe poisonings chelation therapy should be considered.
Microbiology Abstracts C: Algology, Mycology & Protozoology; Toxicology Abstracts; Pediatrics; Hemodialysis; copper sulfate; Aquaria; Suicide; Bleeding; Disinfectants; Vomiting; Chelation; Children; Injuries; Hemolysis; Diarrhea; Gastrointestinal tract; Hypotension; Hospitals; Renal failure; Granules; Poisoning; Intoxication; Pharmaceuticals; X 24161:Acute exposure; K 03400:Human Diseases