| Disease | A 53 YEAR OLD MAN WITH A 4-YEAR HISTORY OF INSULIN-DEPENDENT DIABETES WHO WAS A HEAVY SMOKER AND DRINKER WAS ADMITTED TO A HOSPITAL BECAUSE OF VOMITING, DIARRHEA AND PROGRESSIVE IMPAIRMENT OF CONSCIOUSNESS SOON AFTER INGESTION OF A VEGETABLE
SOUP CONTAINING CA. 500 GM OF SORREL. HE HAD METABOLIC ACIDOSIS, HYPOCALCEMIA, EXTENSIVE LIVER CELL NECROSIS AS EVIDENCE BY ENZYME STUDIES AND PROTHROMBIN RATIO: AND RAISED BLOOD UREA AND SERUM CREATININE, LEVELS. THE PATIENT WENT INTO A
DEEP COMA WITH RESPIRATORY DEPRESSION, KIDNEY AND LIVER FAILURE AND SEVERE METABOLIC ACIDOSIS AND HYPOCALCEMIA. DISTURBANCES IN CARDIAC RHYTHYM PROGRESSED TO VENTRICULAR FIBRILLATION AND THIS WAS THE CAUSE OF DEATH, TWO HOURS AFTER ADMISSION,
WHILE THE PATIENT WAS ON DIALYSIS. A SCREEN FOR COMMON HEPATOTOXINS WAS NEGATIVE. NECROPSY REAVEALED HEPATIC, CENTRILOBULAR NECROSIS, SWELLING AND RETRACTION OF GLOMERULI AND CRYSTALS OF CALCIUM OXALATE IN THE RENAL CORTEX AND VESSELS AND
CAPILLARIES OF LIVER, LUNG AND HEART. THESE FINDINGS WERE CONSISTENT WITH THE CLINICAL PICTURE. THIS MAN INGESTED 6-8 GM OF OXALIC ACID (IN THE SORREL). |