A near fatal case of high dose peppermint oil ingestion- Lessons learnt
A 40 year old female who was brought to the emergency room was suspected to have ingested PPMT oil. A strong smell of mint was emanating from her body. The exact amount ingested could not be ascertained. Clincal examination revealed that the patient was comatosed, had a heart rate of 60/minute, blood pressure not recordable, respiratory rate of 6-8/ minute, oxygen saturation of 30%. Her peripheral pusles were absent and extremities were cold and clammy. Auscultation of chest and precordium revealed normal vesicular breath sounds and normal heart sounds. Patient was immediately intubated without any resistance. Mechanical ventilation (SIMV mode) was instituted (FiO2-1). Gastric lavage was done with warm normal saline. Rapid intravenous infusion of crystalloid was started but her blood pressure did not improve. Thus, intra-venous infusion of dopamine was started, which was gradually increased to 10 μg/kg/min. In the mean time all her clothes were changed and wet sponging was done. Warming blanket and radiant warmer were applied. A 7.0 Fr triple lumen central venous catheter was inserted through right subclavian vein. Her urinary bladder was catheterized. The medication administered include inj ranitidine intravenous (iv), inj ceftriaxone iv, inj gentamycin iv, inj metoclopramide iv and antacid through naso-gastric tube. Since chest skiagram showed no evidence of aspiration and considering the possibility of peppermint oil ingestion causing nephrotoxicity, further dose of gentamycin was stopped. Her vital parameters [], blood investigation reports [] and arterial blood gas analysis [] is given below.\nDopamine infusion was gradually tapered and finally stopped after 8 hours. She started responding to physical stimuli (light glabellar tap) after eight hours and to her name at 24 hours. She was weaned from ventilator after 24 hours. Finally, after 36 hours, patient was conscious, maintaining vitals without support. Chest and cardiovascular examination was unremarkable. Her room air saturation was 100%. She was discharged from intensive care unit.