What is the treatment for copper sulfate poisoning?

Treatment of Copper Sulfate Poisoning

The treatment of copper sulfate poisoning requires immediate chelation therapy with D-penicillamine or trientine as first-line treatment, along with supportive care including early gastric lavage, fluid replacement, and management of complications such as methemoglobinemia with methylene blue. 1

Initial Management

• Decontamination:

  • Perform early gastric lavage if ingestion occurred within 1 hour
  • Activated charcoal administration (though binding capacity for copper is limited)
  • Remove contaminated clothing and thoroughly wash skin if dermal exposure occurred 2

• Supportive Care:

  • Aggressive IV fluid replacement to manage dehydration and prevent renal injury
  • Vasoactive drugs for hemodynamic support if needed
  • Antiemetics for vomiting
  • H2 blockers (e.g., ranitidine) to prevent gastric ulceration 3

Specific Treatments

Chelation Therapy

• First-line agents:
  • D-penicillamine: 750-1500 mg/day in 2-4 divided doses (adult dose)
  • Trientine: 750-1500 mg/day in 2-3 divided doses
  • 2,3-dimercaptopropane-1-sulphonate (DMPS) for severe cases 1, 3
  • Dimercaprol (BAL) for severe poisoning 4

Management of Specific Complications

• Methemoglobinemia:

  • Methylene blue: 1-2 mg/kg IV over 5 minutes 3, 5

• Acute Kidney Injury:

  • Early hemodialysis for severe cases
  • Monitor fluid balance, electrolytes, and renal function 3, 2

• Intravascular Hemolysis:

  • Blood transfusions as needed
  • Monitor hemoglobin and hematocrit 5, 2

• Hepatic Failure:

  • Monitor liver function tests
  • Supportive care 3, 5

• Adrenal Insufficiency:

  • IV hydrocortisone if indicated 3

Monitoring Parameters

• Complete blood count with peripheral smear
• Renal function tests (BUN, creatinine)
• Liver function tests
• Serum copper levels
• Methemoglobin levels
• Electrolytes including calcium
• Urine output 6, 3, 5

Clinical Pearls and Pitfalls

• The lethal dose of copper sulfate can be as small as 10 grams 5
• Symptoms may include dysgeusia, abdominal pain, vomiting, muscle cramps, diarrhea, ink-like urine, jaundice, and anemia 6
• Delayed complications can include rhabdomyolysis and cerebral ischemic events 2
• Chronic kidney disease may develop despite appropriate treatment 6
• Patients with Wilson's disease should be managed differently as they already have copper overload 7

Follow-up Care

• Regular monitoring of renal and hepatic function
• Long-term follow-up for patients who develop chronic kidney disease
• Assessment for delayed neurological complications

The management of copper sulfate poisoning requires rapid intervention with both supportive measures and specific antidotes. Early chelation therapy is crucial for reducing mortality and morbidity in severe cases. The choice between D-penicillamine and trientine may depend on availability and patient-specific factors, but both are effective first-line chelating agents 1.