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Background
[GAMMA]-Benzene hexachloride (GBH) or popularly known as gammaxene is a commonly used insecticide in rural as well as urban households and belongs to organochlorine compounds. Accidental ingestion is not uncommon among children and toxic manifestations comprise chiefly of central nervous system involvement. Acute liver or kidney injury in relation with GBH poisoning rarely reported but simultaneous failure of both these organs in acute GBH toxicity is never reported in literature. Anticipating this unusual yet life-threatening systemic toxicity in the background of GBH poisoning is required from healthcare providers and clinicians. As a corollary, in case of unknown poisoning with acutely precipitated hepatorenal decompensation, GBH poisoning should be ruled out. Moreover, absence of definite antidote and potential exacerbation of symptoms if treated with atropine, need to be addressed by primary care physicians. The triumph of conservative management in our case stresses on the impact of vigilant monitoring and aggressive management which can be lifesaving even in worse situations.
Case presentation
A 30-year-old male farmer from rural India presented to the emergency department 6 h after ingestion of 50 mL of GBH as a suicidal attempt (Scabipid containing GBH 2% with cetrimide 0.5% in emulsion base). There was no history of any other substance abuse. He had no known physical or psychiatric illness. There was no fever, altered sensorium, convulsion or any focal neurodeficit. The patient was given gastric lavage with activated charcoal. His vitals were stable at presentation. General as well as systemic survey including thorough neurological examination at the time of admission was unremarkable. Initial blood...