acute copper sulfate poisoning: case report and review of literature

background: copper sulfate ingestion is a relatively popular method for committing suicide in indian subcontinent. it causes a high mortality rate, and so a growing concern has been raised to identify the severe alarming signs suggestive of poor prognosis and to improve treatment approaches. case report: a 22-year-old unmarried man working as a painter was found unconscious at his friend residence. the patient developed hypotension, hemorrhagic gastroenteritis with hematemesis and melena, renal and hepatic failure, severe metabolic acidosis and intravascular hemolysis during admission at hospital. his signs were refractory to treatment with fluid replacement therapy, vasoactive drugs, antiemetic drugs, ranitidine, furosemide, methylene blue and 2,3 dimercaptopropane-1-sulphonate. he died six hours post-admission. in post-mortem examinations, there were multiple sub-pleural and sub-epicardial hemorrhages and the gastrointestinal mucosa was congested, hemorrhagic, and greenish blue in color. the liver, on histological examination, showed sub-massive hepatic necrosis. on toxicological analyses, copper sulfate was detected in preserved viscera and results for other heavy metals were negative. conclusion: hypotension, cyanosis, uremia and jaundice can be considered as signs of poor prognosis in copper sulfate poisoning. copper sulfate ingestion is life-threatening due to its deleterious effects on the upper gi, kidneys, liver and blood. having no time to waste, aggressive treatments should be immediately instituted and signs of poor prognosis should be kept in mind.