Concluded Case

3 year old female child admitted with accidental ingestion of 6 tablet of Diaminodiphenylsulfone (DDS) Dapsone What are the clinical feature? How will you treat the complications? How long it wil stay in the body ? Methemoglobinemea Treatment Oxygen by mask Iv line collect blood for ABG,CBC,glucose ,serum electrolytes,liver function test ,creatinine G6PD enzyme qualitative and quantitative assay Urine collection for toxicology Oral OGT Activated charcoal Antiemetic Oral or OGT Ascorbic acid 1000mg IV methylene blue loading dose ,followed by continuous infusion Monitor methhaemglobulin Hemolysis by CBC If not responding Exchange transfusion Hyperbaric Oxygen Dapsone level wil stay in the body up to 0ne week Always get the latest treatment of any poisoning from poison centre in that state which will be working 24 \7 Medico legal always consider .sucide/homiside/accidental .

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Methemoglobinemea. Treatment Oxygen by mask IV line Collect Blood ABG Serum electrolytes, glucose ,CBC,creatinine,liver function test ,INR, Blood grouping and crossmatching G6PD assay qualitative and quantitative Urine for toxicology Blood sample should be kept for if some test needed later Insert OGT Activated charcoal Antiemetic Oral or OGT Ascorbic acid 1000mg IV methylene blue loading and continous infusion If G6PD is normal activity Monitor methehaemoglobulin Hemolysis by CBC If not responding to above measures Exchange transfusion Hyperbaric oxygen chamber Dapsone level wil stay in the blood up to 1 weeks Always get the information from poision centre in that state which is open 24/7 Medicolegal always consider sucide /homicide /accidental .

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CLINICAL FEATURES- LETHARGY PERSISTENT VOMITING UNSTEADINESS MILD PERIPHERAL CYANOSIS ATAXIA NYSTAGMUS

Methemoglobinemea. Treatment Oxygen by mask IV line Collect Blood ABG Serum electrolytes, glucose ,CBC,creatinine,liver function test ,INR, Blood grouping and crossmatching G6PD assay qualitative and quantitative Urine for toxicology Blood sample should be kept for if some test needed later Insert OGT Activated charcoal Antiemetic Oral or OGT Ascorbic acid 1000mg IV methylene blue loading and continous infusion If G6PD is normal activity Monitor methehaemoglobulin Hemolysis by CBC If not responding to above measures Exchange transfusion Hyperbaric oxygen chamber Dapsone level wil stay in the blood up to 1 weeks Always get the information from poision centre in that state which is open 24/7 Medicolegal always consider sucide /homicide /accidental .

most frequent reaction that occur with higher DOSE of DDS toxicity is haemolytic anaemia and methemoglobinemia

Hemolytic anemia methhemoglobinemia

METHEMOGLOBINEMIA

TREATMENT methylene blue 0.1 % ( 2 mg/ kg) slow iv first line therapy

PLASMA ELIMINATION HALF LIFE OF DDS IS 10 TO 80 HOURS

TREATMENT -ORAL ADMINISTRATION OF ACTIVATED CHARCOAL

HYPERBARIC OXYGEN ,EXCHANGE TRANSFUSIONS

Dr. Rajeev Gupta Dr. Kavish Mehta sir what u say?