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To the Editor: India faces myriad, inconceivable issues on the medical front. We received a critically ill young infant, with acute onset multiorgan dysfunction syndrome (MODS): encephalopathy, respiratory and hepatic failure, shock, and acute kidney injury. Differentials considered were sepsis (bacterial/viral), inborn errors of metabolism, hemophagocytosis, critical congenital heart disease, and endocrinopathies. To rule out these, investigations including polymerase chain reaction for pathogens and tandem mass spectrometry (TMS) were done but they did not conclusively support any of the above. Continued parent communication revealed history of oral/nasal instillation “therapy” with indigenous oil and plant-based concoctions for a minor cold.
Intensive care supports to combat organ damages included ventilation for lipoid pneumonia, antibiotics, inotropes, fluid management, and blood product transfusions. Urine gas chromatography (GC) revealed dicarboxylic aciduria. Albeit this would form a basis for considering organic academia; these molecules are found in large concentrations in rancid oils (including medium chain triglycerides) and plant products [1]. These red herrings may be taken into consideration by intensivists.
Neuroimaging was suggestive of altered signal intensity: T2/FLAIR hyperintensity, restricted diffusion of periventricular white-matter, basal ganglia, thalami, corpus callosum, and corticospinal-tracts. EEG showed severe bihemispheric dysfunction with burst suppression pattern, that subsequently resolved to normal. The infant improved, was discharged home. Follow-up over the last 5 mo showed evidence of hypertonia and initial slow head growth that is improving with time. Repeat urine GC was reported normal.
Indigenous products and various traditional remedies are being used rampantly with no prior trials, certification processes, or safety/quality control [2, 3]. Till such time that India reaches a state of such system checks, intensivists need to consider toxin-induced MODS [4]. Diligent workup and multipronged intensive care supports would play crucial roles. The infant’s parents were educated about these issues. They now serve as ambassadors for safety of other children in their community by spreading awareness amongst other vulnerable families.
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Hari P, Jain Y, Kabra SK. Fatal encephalopathy and renal failure caused by diethylene glycol poisoning. J Trop Pediatr. 2006;52:442–4.
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John, E.M., Kolisambeevi, A.A., Pournami, F. et al. Magic Potion, Concoction, or Poison? Multiorgan Dysfunction Syndrome and Dicarboxylic Aciduria after Quack Prescriptions. Indian J Pediatr 89, 817 (2022). https://doi.org/10.1007/s12098-022-04242-9
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DOI: https://doi.org/10.1007/s12098-022-04242-9