A six-years-old girl was brought to the Emergency Department (ED) of Kalaiya District Hospital, Bara, Nepal after ingestion of 5 gram of LURA (brand name of Emamectin Benzoate 5.00% w/w Soluble Granule SG) with complaints of nausea, vomiting and abdominal pain.
She has mistaken LURA for “JALJEERA” (powder form of cumin used in beverage) and ingested a packet of it (5 gram packet) by mixing with water. When she started having repeated bouts of nausea, vomiting for 3 episodes and abdominal pain, she was brought to ED by her parents. Later at ED, on asking her if she had eaten anything, she told that she had taken “JALJEERA” which she took out of her pocket then. But it was found to be a packet of “LURA” instead. The packaging was similar to a packet of “JALJEERA”. So, the child was easily confused. A provisional diagnosis of Emamectin Benzoate Poisoning was made.
On examination, she was oriented to time, place and person. She was awake and alert but mildly confused and irritable. Her pulse rate was 94 beats per minute and regular. Her respiratory rate was 22 per min., axillary body temperature was 98.4 ֯ F and SpO2 was 98%. Pupils were isocoric with normal light reflex. On respiratory examination, breath sounds were clear bilaterally. On cardiovascular examination, first and second heart sounds were audible with no murmur or added sounds. The abdomen was soft, flat and without tenderness or rebound tenderness.
Limited investigations were done. The laboratory findings were as follows: hemoglobin 13.8 mg/dl, white blood cells count 7700/mm3, platelet 170000 /mm3, Na+ 136 mEq/L, K+ 4.2 mEq/l, Serum Urea 26 mg/dl, Creatinine 0.9 mg/dl, RBS 82 mg/dl, Urinalysis normal. The Chest X-ray was normal.
Patient was then started gastric lavage with 2L normal saline, 60 gm. activated charcoal and 500 ml coconut oil. She was given Injection Pantoprazole 20 mg IV, Injection Ketorolac 15 mg slow IV, Injection Ondansetron 2mg IV & Injection Hydrocortisone 50 mg slow IV for symptoms management. After 30 minutes of gastric lavage, she was shifted to general medical ward for observation for 24 hours with nasogastric tube in situ. She was kept nil per oral (NPO) till 24 hours and given IV hydration. Vitals and systemic examination were assessed 4 hourly in ward, which were found to be normal. After 24 hours, her symptoms were improved and she was more alert & playful. So, oral sips were allowed followed by liquid, which was gradually advance to semisolid and solid diet. After 48 hours of total hospital stay, she was discharged with proper counseling on some oral medications (Tab. Pantoprazole + Domperidone & Oral Rehydration Solution) to use as needed & advised for follow up after 1 week in clinic.
In follow up after 1 week, she did not have any presenting complaints. Vitals and systemic examinations were in normal limit.