In a first-of-its-kind, doctors of Sir Ganga Ram Hospital have successfully performed a rare plasma exchange on a 14-year-old boy who had consumed mosquito repellent after having tiff with parents and decided to end his life.
The 60-hour procedure involved the separation and removal of the plasma from the blood in order to clean it, where he was admitted last year in November in the casualty in a critical condition with liver and kidney at a risk of failure. His haemoglobin level was very low at 3.6 (normal 13+).
“The methemoglobin level was high which meant that oxygen supply to vital organs was getting reduced. There was very high risk of irreversible damage to his organs,” said Dr Anil Sachdev, Director of Pediatric Emergency at Critical Care and Pulmonology Department of
Sir Ganga Ram Hospital.
While the doctors tried all latest protocols to resuscitate him and to make his body immune to increase his urine output so that his kidneys could be salvaged. Further tests revealed that he was suffering from Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) and treatment protocol needed to be changed.
While explaining the challenges of whole procedure, Dr Sachdev said, “At this stage, we decided to perform urgent plasma exchange, a procedure involving the separation and removal of the plasma from the blood in order to remove disease substance circulating in the plasma,” adding, “the red blood cells, white blood cells and platelets have been returned to the patient along with a prescribed replacement fluid,” explained Dr Sachdev.
“Even though evidence for plasma exchange in literature is limited to case reports, we decided to give this therapy to our patient in view of G6PD deficiency. In our knowledge, no case was reported till date to have these complications after transfluthrin ingestion,” he said.
Transfluthrin is a synthetic pyrethroid derivative used as insecticide. Kerosene is the solvent used in the preparation of liquid mosquito repellent vaporiser. There is no specific antidote for transfluthrin toxicity.
After a 60-hour plasma exchange, the condition of the boy started improving and he was shifted to ward. Six days later, he was discharged from the
hospital in stable condition. The survival case study was published in the Journal of a Clinical Toxicology recently.