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Bluish vomiting is a symptom of poisoning that is rarely seen in Western emergency departments. Consequently, physicians are not aware of the diagnosis, complications, and treatment of this unusual form of intoxication. In this article, we report a case of bluish vomiting that occurred after an accidental ingestion of copper sulphate. In the discussion, we review three life-threatening causes of bluish vomiting (copper sulphate, boric acid, and paraquat ingestion), and we discuss their respective clinical manifestations, specificities, complications, and management therapies.
Keywords: Bluish vomiting, Copper sulphate, Boric acid, Paraquat
Introduction
Bluish vomiting, which can occur after acute poison- ing, is rarely encountered in Western emergency departments. Most cases of bluish vomiting are from reports in the countries of Southeast Asia and are often linked with self- (adults) or accidental (children) poisoning by substances such as copper sulphate, boric acid, and paraquat. According to PubMed, there are no comprehensive reviews that discuss all of the causes of bluish vomiting. Moreover, in Western countries, the previously mentioned intoxications are not frequently encountered, which can make it difficult to diagnose and treat when first detected.
The clinical case presented in this paper presents the incidental ingestion of a liquid, while the patient worked in the garden. Therefore, we decided to focus the discussion on toxins that may be present in a garden shelter. Other causes of bluish vomiting, such as ink, candy, paints, or blue-coloured liquid inges- tion, are excluded from the discussion.
Given the potentially severe outcomes of ingestion of these poisons, physicians should always include them in their differential diagnosis and be aware of the management strategies for such patients. Rapid identification of the specific symptoms of these poisons can facilitate early appropriate therapy.
In this case report, we review the specificities, com- plications, and various therapies for these poisons.
Case Presentation
A 65-year-old man was admitted to a Belgian emergency department after ingestion of approxi- mately 25 ml of an unknown liquid substance in a green bottle marked sparkling water. He was working in his garage and decided to drink sparkling water to quench his thirst. The first symptom was blue-green vomiting (Fig. 1). He also presented with dysenteric syndrome, consisting of nausea, abdominal pain, and diarrhea. No cardiac, respiratory, or urinary symp-...