A 31-year-old male, with no history of interest except moderate smoker, was admitted to the emergency department after voluntary ingestion of approximately 14 hours before, about 100 cc of extra 20% Gramaxone®.
The patient complained of abdominal pain, discomfort in the oral cavity and intense vomiting.
At the initial physical examination, the patient was conscious and oriented temporally and spatially, normotensive (140/80 mmHg), with a heart rate of 94 beats per minute and an axillary temperature of 37.3 oC.
Oral cavity examination revealed erythematous lesions in the oropharynx.
The abdomen was painful to palpation, without defense or signs of peritoneal irritation.
Laboratory studies highlighted: hemoglobin 15 g/dl, hematocrit 46%, 14,500/mm3 neutrophils 84%, platelets within normal limits e.g., creatinine 200 mg/dl, AST 2.1 U/dl.
The chest X-ray showed a slight reinforcement of the bronchial network.
The determination of sodium dithionite was positive.
Initially, in addition to serum mannitol 20%, activated charcoal and Füller soil by NGT were administered, as well as vitamin C and gastric protectors.
The patient was transferred to the Intensive Care Unit where hemoperfusion with activated clot cartridges was initiated.
After the first session she suffered an episode of severe hypotension that required treatment with vasoactive amines.
Subsequently, she developed a picture of emphysema and melena.
During a new hemoperfusion session there was respiratory arrest resulting in tracheal intubation and mechanical ventilation.
During the following hours, the patient developed severe hemodynamic instability and cardiac arrest due to electromechanic instability, which was refractory to all therapeutic measures, and died 12 hours after admission.
