praveen malavade - T۵, Resident quarters,Subbaiah medical college Purle
suprita shivalingappa - Department of Medicine, SIMS, shivamogga

Acute poisoning is an important medical emergency. Depending on the socioeconomic factors and cultural diversity, the nature of poison varies throughout the world even in different parts of the same country. Hence, the management of these patients can improve if the common causes of poisoning are properly defined. Pesticide poisoning is globally the single most important means of suicide. It is a major public health problem in rural Asia, where it has led to a very high-case fatality ratio in comparison to the developed world. Case Series: we report four cases of extremely rare poisoning with ۲-۴-D, Sodium Salt, all of which were due to suicidal attempt. In this case series, we attempt to describe the clinical and biochemical profile of this rare poison. The presenting symptoms were nausea,vomiting, abdominal pain, and altered behavior/sensorium. All cases had hypernatremia/ high anion gap metabolic acidosis, yet the degree of which varied across cases. Two of them had only Hypernatremia and acidosis, and improved with conservative treatment. One of them developed severe renal, hepatic and respiratory failure and succumbed. Another case had hypernatremia, acidosis, AKI. He improved drastically after dialysis. Conclusion: We would like to highlight in our case series that timely management, could alter the outcomes in this poisoning.  

Hypernatremia, Metabolic acidosis Dialysis, Poisoning