A female went into a coma after ingesting an unknown quantity of peppermint oil. She required mechanical ventilation and rigorous treatment!
A 40-year-old female presented to the emergency room after her family suspected that she has ingested peppermint oil. At the presentation, there was a strong smell of mint emitting from her. The exact amount ingested remained unknown.
On examination, the patient was in a coma with a heart rate of 60 per minute, respiratory rate of 8 per minute, oxygen saturation of 30%. However, her blood pressure was not recordable, her peripheral pulses were absent, and the extremities were cold and clammy.
Chest auscultation revealed normal vesicular breath sounds. Examination of the precordium was unremarkable.
The doctors immediately intubated the patient. Also, they performed gastric lavage with warm normal saline. Despite intravenous fluid infusion, her blood pressure did not improve. Therefore, the doctors started her on intra-venous dopamine. Simultaneously, they decontaminated her; changed all her clothes followed by wet sponging. A warming blanket and radiant warmer were applied.
The doctors inserted a central venous catheter through the right subclavian vein. Her urinary bladder was catheterized. Moreover, she received ranitidine intravenous, intravenous ceftriaxone, intravenous gentamycin, intravenous metoclopramide, and antacid through a nasogastric tube.
The doctors ruled out aspiration through imaging. Additionally, ECG showed sinus bradycardia.
The doctors considered a working diagnosis of peppermint oil-induced nephrotoxicity, therefore, they stopped gentamycin. Clinically, she improved over the next couple of hours.
Gradually her doctors tapered the dopamine infusion. Subsequently, they stopped the dopamine infusion 8 hours later.
With adequate management, fortunately, she started responding to physical stimuli and to her name at 8 hours and 24 hours, respectively. The doctors weaned her off from the ventilator after 24 hours.
After 36 hours, she was conscious stabilised. She was able to maintain 100% oxygen saturation on room air. Consequently, they discharged him from the ICU.