Plasma exchange successful on boy who took mosquito repellent

Doctors at a city hospital have successfully performed a rare plasma exchange on a 14-year-old boy who had consumed mosquito repellent.
The 60-hour procedure involving the separation and removal of the plasma from the blood in order to clean it, was done by doctors at Sir Ganga Ram Hospital where he was admitted on November 1 last year after consuming the toxic liquid over a tiff with his parents.
"When we received the child in our casualty, he was in a critical shape. His hemoglobin was at dangerously low levels of 3.6 (normal 13+). The liver was affected with jaundice and kidneys were at high risk of failure.

"The methemoglobin levels were rising 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 Pulmonolgy department of Sir Ganga Ram Hospital.
Latest protocols were tried to resuscitate him and to increase his urine output so that his kidneys could be salvaged. Further tests revealed that he was suffering from G6PD deficiency and treatment protocol needed to be changed.
"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.

"The red blood cells, white blood cells and platelets are 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 an insecticide. Kerosene is the solvent used in the preparation of liquid mosquito repellent vaporizer. 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.