Had a pt 36 yr old with 8 wks pregnancy come in today with seizures and metabolic Acidosis. There was a h/o oral consumption of 30 ml of #eucalyptus oil.
There was no kidney dysfunction. I was called for Rx of Acidosis. I have not seen eucalyptus oil poisoning before.
In adults, death is commonly seen after ingestion of 30 ml, but can be encountered after 4-5 ml also.
In children, a dose of 2-3 mL can induce mild CNS depression with drowsiness and/or dizziness and ataxia. A dose of ≥5 mL can induce significant CNS depression with coma.
Eucalyptus oil inhalation can also induce seizures. A study from #Bangalore from @apollohospital @SakraHospital & St Johns Medical College Hospital report 10 cases of EO inhalation–induced seizures, 8 patients had GTCS and two had CPS. onlinelibrary.wiley.com/doi/full/10.10…
Essential oils of 11 plants are powerful convulsants (eucalyptus, fennel, hyssop, pennyroyal, rosemary, sage, savin, tansy, thuja, turpentine & wormwood) due to highly reactive monoterpene ketones - camphor, pinocamphone, thujone, cineole, pulegone, sabinylacetate & fenchone.
Pt remains drowsy but arousable. No further seizures. After iv bicarb infusion, the ABG...

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More from @arvindcanchi

Mar 3
A masterclass on hyperammonemia and Inborn Errors of Metabolism by @rupeshrainamd at the Critical Care Nephrology Course in Delhi today.
#criticalcarenephrologyindia #pcrrtadvances #critcareneph23 ImageImageImageImage
The pressing need to dialyze the pt with hyperammonemia (without renal dysfunction) was emphasized repeatedly by @rupeshrainamd at the Critical Care Nephrology Course in Delhi.
#criticalcarenephrologyindia #pcrrtadvances #critcareneph23 ImageImage
A video excerpt from the talk by @rupeshrainamd at the Critical Care Nephrology Course in Delhi.
#criticalcarenephrologyindia #pcrrtadvances #critcareneph23
Read 4 tweets
Feb 15, 2022
ECG of a 65 yr old male pt who was admitted with AoCKD, Screat of 4.1 mg (was 2.6 mg 3m ago). K was 9.0
What changes of hyperkalemia do you see on this ecg? Why is there no Bradycardia or "sine wave" pattern? How would you Rx this?
#Meded #nephtwitter
The possibility of pseudohyperkalemia was considered especially blood sample lysis. Nevertheless Rx of hyperkalemia was started in right earnest and a repeat fresh sample of blood was sent, drawn without applying a torniquet.
(Pic courtesy : ijcasereportsandimages.com/archive/articl…)
The repeat sample came back with a K of 8.1 meq. So this was true hyperkalemia.
Medical mgmt of K and the option of dialysis was discussed with the pt and relatives.
Read 10 tweets
May 14, 2021
A Thread.
The Indian Government has increased the gap btw the two doses of #COVID19 vaccination to 3 to 4 months now, ostensibly to improve protection but actually bcos of vaccine stock deficiency. This should NOT apply to Chronic Kidney Disease pts, #Dialysis & Transplant pts.
CKD pts, #dialysis and Transplant pts run a very high risk of morbidity and mortality (4 fold) with #COVID19 infection, much higher than diabetics and pts with heart disease or asthma (1.2 to 2 fold)
Data from India has also shown high mortality (38%) in dialysis pts. Study by @MayuriTrivedi80 et al
Read 12 tweets
Mar 18, 2021
This is a Thread about the Indian caregiver.
Most #CKD & #Dialysis pts come with their relatives as caregivers when they come for an OP consult. Usually it is the spouse & sometimes, the children. I make it a point to enquire about their health even though they are not my pts 1/n
I will tell you why I do that with a couple of real-life events. My 55 yr old #CKD Pt came without her husband for a consult which was unusual. When I asked her, she started bawling out in distress, saying that he'd died of a heart attack the previous month. 2/n
He was 60 years of age and hypertensive, but it appears that he never bothered to go for his regular BP check or for that matter an annual cardiac check. I didn't know of this & wondered at the time, should I have asked him how he was during his many visits to my OP chambers? 3/n
Read 8 tweets

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