Suspected case of Alphos poisoning

Take personal protection measures, including full face mask and rubber gloves during

decontamination

Secure airway, IV access preferably CVP and send routine investigations

Gut decontamination with KMnO4(1:10,000), vegetable or coconut oil(within 6 hrs)

Watch for worsening of signs and symptoms

SHOCK• Fluid

therapy @ 2-3 litres NS in first 8 hours to maintain CVP of 12-14 cms Saline

No response• Low dose

dopamine (4-6 ug/Kg/min) and keep systolic BP>90 mm Hg

Refractory hypotension• Consider

IABP

ORGAN FAILURE

ALI/ARDSVentilatory support

Hydrocortisone 200-400 mg every 4-6 hr IV

ARRYTHMIASAntiarrythmics and MgSo4 3

g as infusion over 3 h, followed by 6 g per 24 h for

3–5 days,Bradyarrythmia can be considered for pacing

METABOLIC ACIDOSISNaHCo3 50-100 mEq IV 8

hrly till the level rises to 18-20 mEq/L

DIALYSIS for renal failure and severe acidosis: HDM/ PD(if hypotension present)

MANAGE ACCORDINGLY

SUPPORTIVE MEASURES:• Antacids and proton pump blockers • n-acetylcysteine, glutathione, melatonin,

vitamin C and beta carotene• trimetazidine