Despite the widespread use of potassium permanganate, cases of. Poisoning with this substance are comparatively rare, and in view of the ease with which the ...
A
FATAL
OF
CASE
GRACE
PERMANGANATE
POTASSIUM
POISONING.
/
M.^RITCHIE.lM.B.,
from the Western District and Stobhill
Ch.B.
Hospitals, Glasgow.
the widespread use of potassium permanganate, cases of this substance are comparatively rare, and in view of with Poisoning the ease with which the present fatality occurred, the following account more is presented, in the hope that the dangers of this substance will be
Despite
widely recognised. CASK REPORT.
^arch, !!)??-,
ol"
healthy child, aged one year, was playing with a full Potassium permanganate crystals. While lying oil 'his mother's ,?^,of knees ili?e le ehilfl the box, spilling the contents over his face and into his upturned liiouti', e^es' Approximately 7 grams appeared to have been taken into his uiouth a,ri le ,m?ther at once sponged the crystals from his face and eyes, and brought hijn tto hospital, fifteen minutes after the accident occurred. f^ar^ brown staining of the left eye, lips and mouth was noted, hut hi'1 C?.linati?. -10n WaS ?ther\vise good. Lavage of the stomach was performed with a Wenl- C011, so'ution of sodium bicarbonate; the aspirated material contained food Partiol brown crystals. In view of the possible eye damage, the child was refert-fiT r*?r sPecia'ist ophthalmological opinion, and thereafter admitted to a Uieriio i two
a
,
ward three hours after the accident. ^la
In
a few cases, as in the present report, autopsies have revealed necrosis in the liver and kidney tubules, with fatty change (Siegel, 192/5 ;
1
alniieri, 1933). Leschke (1934) quotes a case (Volhard) in which Potassium permanganate was taken during pregnancy, with the developof nephrosis, and in the series of thirty-one cases reported by kreen and Warr (1941) there were four instances of renal irritation, marked by varying degrees of bilateral lumbar haematuria and
ment
'
pain,
oliguria.'
Experimentally, in animals, it has also been shown (Born et al., 1943), smg radioactive manganese intravenously, that the highest concenration by far is in the liver and kidneys, while the concentration in the rain is only one-seventieth of that in the liver. In addition it has been enionstrated 111
animals
can
(Sollmann, 1948) that oral result in hepatic cirrhosis
It would therefore
seem
probable,
administration of manganese and
that
nephrosis. although the patient
may
appear to be improving following recovery from the initial shook and relief of respiratory obstruction, to the liver and
kidneys by
damage
a
^sorbed manganese may be severe enough to cause death, as in the present case. It is interesting to note that rather similar lesions have been found 11
the liver, both
experimentally and in cases of poisoning by tablets sulphates of iron, copper and manganese (Forbes, 1947 ; b?mers, 1947; Prain, 1949). -treatment of acute potassium permanganate poisoning necessitates containing prompt ect
^
the
and
energetic
measures
to combat the instantaneous oxidative
mucous membranes. To protect the latter, poison white and/or milk should be given in large quantities and an attempt 1ade at gastric lavage if a soft tube can be passed easily. Theoretically
the
on
the
amounts of
should also
ascorbic acid, powerful reducing agent, ^aiV,e^lpful, but prolongation of the reducing effect might lead to increased a
6
readily absorbable manganous salts. The tracheotomy la> be required, and at a later stage, even gastrostomy. If much mucosal aniage has occurred, antibiotics should be given to combat sepsis.
0rniation of
more
sual resuscitative
It must be ?
eriously 1Ust
no
kept
soluble and
measures
emphasized
for shock should be undertaken ;
that every
case
of
poisoning should
be
regarded
poison has been taken, and the patient under observation for at least several days. It would also
matter how little
eertl )e
desirable that the potency and dangers of such a substance should more widely known and its availability restricted. SUMMARY.
A fatal case of poisoning by potassium permanganate is reported. A review of the literature is included, with special emphasis on
