Pyloric stenosis following ingestion of potassium permanganate

Hot charcoal vomitus in aluminum phosphide poisoning - A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature

Aluminium phosphide (ALP) poisoning is a commonly encountered poisoning in emergency departments in most developing countries. Many papers have revealed metabolic derangements in this poisoning and also examined contributing factors leading to death, but only few have reported physical damage. Some case reports have described a complication that has been frequently termed ‘ignition’. The exact mechanism of this phenomenon has not been fully elucidated. An exothermic reaction during therapeutic administration of chemicals may contribute to this problem, but the incidence has occurred in the absence of treatment or drug administration. Here, we report a 34-year-old woman with ALP poisoning who presented with hot charcoal vomitus, a sign of internal thermal event, leading to the thermal burning of the patient's face and internal damage resulting in death. We reviewed all reported cases with similar complication to demonstrate varied characteristics of patients and to propose the possible mechanisms leading to this event.

Emergency Do Not Consume/Do Not Use concentrations for potassium permanganate in drinking water

Over the past decade, regulatory authorities and water purveyors have become increasingly concerned with accidental or intentional adulteration of municipal drinking water. Emergency response guidelines, such as the ‘Do Not Consume’ or use concentration limits derived herein, can be used to notify the public in such cases. Potassium permanganate (KMnO4) is used to control iron concentrations and to reduce the levels of nuisance materials that affect odor or taste of finished drinking water. Manganese (Mn) is recognized an essential nutrient, permanganate (MnO4−) and manganous (Mn+2) ions are caustic, and the acute toxicity of KMnO4 is defined by its oxidant/irritant properties and by the toxicity of Mn. Ingestion of small amounts (4–20 mg/kg) of aqueous KMnO4 solutions that are above 200 mg/L causes gastrointestinal distress, while bolus ingestion has caused respiratory arrest following coagulative necrosis and hemorrhage in the esophagus, stomach, or liver. Dilute KMnO4 solutions (1–100 mg/L) are used as a topical antiseptics and astringents, but >1:5000 (200 mg/L) dilutions can irritate or discolor sensitive mucous membranes and direct skin or ocular contact with concentrated KMnO4 can perforate tissues. Based on clinical experience with 200 mg/L KMnO4, a Do Not Consume concentration of 7 mg/L KMnO4 (equivalent to 2 mg Mn/L) is recommended. Recognizing limited empirical data from which to calculate an ocular reference value, a skin contact ‘Do Not Use’ concentration of 30 mg Mn/L is recommended based on the skin irritation in some patients after a 10-min contact with 100 mg KMnO4/L.

Unintentional ingestion of potassium permanganate

This case of an unintentional ingestion of an unknown amount of potassium permanganate by a 5-year-old boy, and its sequelae, exemplifies the potential danger of this poison. Due to the wide availability of this agent in over-the-counter preparations and the high potential for serious sequelae, clinicians should be aware of the actions of this agent, as well as the diagnostic and management features associated with it.

Manganese

Manganese is a very hard, brittle metal, which is used to increase the strength of steel alloys. Absorption from the gastrointestinal tract occurs in the divalent and tetravalent forms. Permanganates, which are strong oxidizing agents, have a +7 valence. The principal organomanganese compound is the anti-knock additive, methylcyclopentadienyl manganese tricarbonyl. Manganese is a ubiquitous constituent of the environment comprising about 0.1% of the earth's crust. For the general population, food is the most important source of manganese with daily intake ranging from 2-9 mg Mn. Combustion of gasoline containing methylcyclopentadienyl manganese tricarbonyl releases submicron particles of Mn3O4 that are potentially respirable. Biomagnification of manganese in the food chain probably does not occur. The lungs and gastrointestinal tract absorb some manganese, but the relative amounts absorbed from each site are not known. Homeostatic mechanisms limit the absorption of manganese from the gastrointestinal tract. Elimination of manganese occurs primarily by excretion into the bile. Animal studies indicate that manganese is an essential co-factor for enzymes, such as hexokinase, superoxide dismutase, and xanthine oxidase. However, no case of manganese deficiency in humans has been identified. Manganism is a central nervous system disease first described in the 1800s following exposure to high concentrations of manganese oxides. Manganese madness was the term used to describe the initial psychiatric syndrome (compulsive behavior, emotional lability, hallucinations). More commonly, these workers developed a Parkinson's-like syndrome. Currently, the risks of exposure to low concentrations of manganese in the industrial and in the environmental settings (e.g., methylcyclopentadienyl manganese tricarbonyl in gasoline) are being evaluated with regards to the development of subclinical neuropsychological changes. The American Conference of Governmental and Industrial Hygienists recently lowered the TLV-TWA for manganese compounds and inorganic manganese compounds to 0.2 mg Mn/m3.

Potassium permanganate poisoning--a rare cause of fatal self poisoning

Attempted suicide by self poisoning is common because of the ready availability of drugs, whether prescribed or bought over the counter. In some cases, the ingestion of seemingly innocuous household products or chemicals can result in death. Potassium permanganate is an example. Poisoning with potassium permanganate can be fatal when a significant amount is ingested, as shown by a patient who suffered both the corrosive and systemic toxic effects of this chemical.

Fatal acute hepatorenal failure following potassium permanganate ingestion

Potassium permanganate (KMnO4), a powerful oxidizing agent, is readily available without prescription. Tissue contact produces coagulation necrosis and the lethal consequences of oral ingestion are well described, with most deaths because of airway oedema and obstruction or circulatory collapse. Whilst systemic toxicity is reported, its mechanism is unclear. We describe a case of suicidal ingestion of KMnO4 followed by acute hepatorenal toxicity resulting in the death of the patient. The clinical course bore close resemblance to that of severe paracetamol overdose. We discuss the pathogenesis of the systemic toxicity of KMnO4 and postulate that it is due to oxidative injury from free radicals generated by the absorbed permanganate ion. We recommend that N-acetyl cysteine be given within the first few hours to all patients with potassium permanganate poisoning.

Ingestion of potassium permanganate crystals by a three-year-old boy

We report a case of corrosive burns to the mouth, oesophagus and trachea in a three-year-old boy who ingested potassium permanganate crystals. The pathophysiology and treatment options are discussed. The prevention of accidental ingestion could be improved with careful packaging of the solid tablet or crystalline forms.