Treatment of Cow Dung Powder (Auramine-O) Poisoning

Cow dung powder poisoning requires only symptomatic and supportive treatment, as there is no specific antidote for Auramine-O toxicity. 1

Immediate Management

Secure the airway immediately and provide respiratory support, as respiratory depression is one of the most common and life-threatening manifestations of this poisoning 1
Establish intravenous access and initiate continuous cardiac monitoring, as cardiotoxicity including toxic myocarditis, arrhythmias, and cardiac failure can occur 2
Administer 100% oxygen if respiratory distress is present 1

Do NOT induce vomiting, as this is contraindicated in all poisoning cases and can cause aspiration 3
Do NOT perform gastric lavage if the patient has already developed symptoms, as this increases risk of complications 3
Activated charcoal is NOT recommended for cow dung powder poisoning unless specifically directed by poison control, as there is no evidence supporting its use and it may cause harm including aspiration 4

Treat vomiting with antiemetics as needed, since gastrointestinal symptoms including vomiting are common presenting features 1, 5
Provide aggressive fluid resuscitation to maintain hemodynamic stability and support renal function 1
Monitor and correct electrolyte abnormalities as they develop 1

Obtain baseline complete blood count, renal function tests (RFT), liver function tests (LFT), and blood sugar level (BSL) on presentation 1
Perform serial cardiac monitoring with ECG and cardiac biomarkers, as toxic myocarditis can develop even without initial cardiac symptoms 2
Obtain CT brain if altered mental status or CNS symptoms develop, as CNS involvement is common 1

Mortality is low when treatment is initiated promptly, with most patients recovering with supportive care alone 1
Complete recovery is possible even in cases complicated by toxic myocarditis and cardiac failure, though this may take time 2
Young females are the most commonly affected demographic group 1

Do not delay respiratory support while waiting for diagnostic confirmation, as respiratory depression can be rapidly fatal 1
Do not assume cardiac involvement is absent based on initial presentation alone—cardiac toxicity including myocarditis can develop during the clinical course 2
Do not use antimotility agents like loperamide or Lomotil if gastrointestinal symptoms are present, as these are not indicated and may worsen outcomes 4
Do not attempt neutralization with any agents, as this provides no benefit and may cause additional harm through exothermic reactions 3

Contact your regional Poison Control Center immediately for guidance on management and to report the case, as this poisoning is rare and additional expert consultation may be beneficial 3