ACASE OF COPPER SULFATE INTOXICATION THAT IS PRESENTED WITH PROLONGED HEMOLYSIS AND ACUTE RENAL FAILURE
Journal Name:
- İstanbul Tıp Fakültesi Dergisi
Keywords (Original Language):
| Author Name | University of Author | Faculty of Author |
|---|---|---|
Abstract (2. Language):
Copper sulfate is a fungicide used for the control of bacterial and fungal diseases of vegetables, fruits, and grain
products. Even a very small quantity is toxic. Its acute toxicity leads to hemolytic anemia, acute tubular necrosis,
hepatotoxicity, and rhabdmyolysis.
A55 year old man was hospitalized with nausea, vomiting and epigastric pain. We found hemolytic anemia, acute
renal failure, hepatotoxicity (only an increase in AST) and rhabdomyolysis as a consequence of oral copper sulfate
intake for suicidal purposes. The amount of urine was 3-4 L/day. D-penicillamine (900 mg/day) was started. Metabolic
acidosis was recorded. Hemodialysis was performed 9 times in twenty days. Increased copper levels in serum
and urine and methemoglobinemia levels decreased gradually (210 μg/dl→92 μg/dl, 98 μg/24 hour→62 μg/24
hours, 2.1%→1.6%, in the order given). Uric acid, phosphorus and bicarbonate levels were at normal levels in the
urine. Anemia started to decrease on the 15th day of hemolysis and it recovered on day 30. Since nitrogen retention
did not regress at the end of week three, renal biopsy was performed. Acute tubular necrosis was detected in the
biopsy. The renal functions returned to normal levels on day 30. As result although renal function is normal, hemodialysis
treatment together with chelating agent should be performed at an early stage in such patients.
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Abstract (Original Language):
Bak›r sulfat, sebzelerin, meyvelerin ve tah›l ürünlerinin bakteriyel ve fungal hastal›klar›n›n kontrolü için kullan›lan
bir fungusiddir. Çok küçük miktarlar› dahi toksiktir. Akut toksisitesinde hemolitik anemi, akut tubuler nekroz, hepatotoksisite
ve rabdomyoliz geliflir.
Ellibefl yafl›nda bir erkek hasta midede yanma, bulant›, kusma ve epigastrik a¤r› yak›nmalar› ile baflvurdu.
‹ntihar amac›yla oral bak›r sulfat al›m›na ba¤l› hemolitik anemi, akut böbrek yetersizli¤i, hepatotoksisite (sadece
artm›fl AST) ve rabdomyoliz saptand›. ‹drar miktar› 3-4 L/gün olarak seyretti. D-penisilamin (900 mg/gün) baflland›.
Metabolik asidoz kaydedildi. Yirmi günde 9 kez hemodiyaliz uyguland›.
Serum ve idrarda artm›fl bak›r düzeyleri ve yüksek methemoglobinemi düzeylerinde yavafl yavafl azalma gözlendi
(210 μg/dl→92 μg/dl, 98 μg/24 saat →62 μg/24 saat, 2,1%→1,6%, s›ras›yla). ‹drardaki ürik asid, fosfor ve bikarbonat
düzeyleri normaldi. Hemolizin 15. gününden itibaren gerilemeye bafllayan anemi 30.günde tamamen düzeldi.
Azot retansiyonunun üçüncü haftan›n sonunda da gerilememesi üzerine böbrek biyopsisi yap›ld›. Akut tubuler
nekroz gösterildi. Böbrek fonksiyonu 30. günde normale döndü.
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