Delayed Presentation of Acute Copper Sulfate Poisoning with Persistent Acute Kidney Injury and Hemolytic Anemia: A Case Report

Abstract

Aims: Copper sulfate poisoning is an uncommon but potentially life-threatening toxicological emergency frequently encountered in agricultural settings due to the easy availability of copper-containing pesticides. It can result in severe multi-organ dysfunction involving the gastrointestinal, hematological, hepatic, renal, and neurological systems. This case report aims to describe the clinical presentation, management, and outcome of delayed copper sulfate poisoning with significant systemic complications and to highlight the importance of early recognition and supportive care. Presentation of Case: A 37-year-old male agricultural worker presented five days after intentional ingestion of approximately 20–30 mL of Mastercop (copper sulfate 50% WP). He developed recurrent vomiting, diarrhea, melena, jaundice, reduced urine output, generalized weakness, and altered sensorium. Initial laboratory investigations revealed acute kidney injury with markedly elevated serum creatinine and blood urea levels, hemolytic anemia, elevated lactate dehydrogenase, leukocytosis, and hypoalbuminemia. Prior to referral, the patient underwent three sessions of hemodialysis and received three units of packed red blood cells. During hospitalization, he was managed conservatively with intravenous fluids, antibiotics, proton pump inhibitors, antioxidants, hematinics, electrolyte correction, and nutritional supplementation, along with close monitoring of renal and hepatic parameters. Discussion: Copper sulfate toxicity produces corrosive gastrointestinal injury, oxidative hemolysis, hepatic dysfunction, methemoglobinemia, and acute tubular necrosis. Delayed presentation is associated with increased morbidity due to progressive oxidative tissue injury. Persistent renal impairment despite hemodialysis in this case reflects the poor dialyzability of copper and the severity of systemic toxicity. Conclusion: Early supportive management, timely hemodialysis, and multidisciplinary care contributed to patient survival despite delayed presentation and severe poisoning. Psychiatric counseling, public awareness, and stricter pesticide regulation remain essential for prevention and reduction of poisoning-related morbidity and mortality.