JOIN USA young doctor, who tried to commit suicide in the most unusual manner, was given a new lease of life by doctors at the Sir Ganga Ram Hospital (SRGH) here after successfully attempting charcoal-based hemoperfusion.
The 32-year old doctor, failing to cope up with day-to-day pressures, thought of ending his life and chose an unusual method. The doctor chose two drugs for definite cardiac arrest.
Simultaneously, he injected himself with large units of regular insulin to drop his blood sugar levels to dangerous levels, which if unchecked leads to comatose state and severe brain damage.
As the drugs started to have their effect, the doctor had a sudden change of mind–he wanted to live.
He informed his relatives and was immediately rushed to the casualty of SGRH within two hours of him ingesting the drugs late on June 2013.
The doctors in the Department of Critical Care were perplexed by the unique mixture of drugs taken in large quantity. “I had never seen in my practice of 25 years, this unique and deadly concoction as a method to commit suicide. The challenge for us was to find an antidote.
“But this is was not readily available in India and moreover the cost of one vial is about $1,600, about Rs 1,00,000, and we needed 15-20 vials, costing around Rs 15-20 lakh. Time was running out and patient’s condition deteriorated,” said Dr Sumit Ray, vice-chairperson of department of critical care.
A team of cardiologists, nephrologists and critical care specialists after a thoughtful deliberation decided to attempt charcoal-based hemoperfusion.
“This method which costs about Rs 4,500 per cartridge, is used for removing drug related toxins but has been rarely been attempted for Digoxin. There has been only anecdotal references in International literature. We were pleasantly surprised by the results, as after 15 hours of hemoperfusion with 2 cartridges of this activated charcoal based adsorbent, the serum digoxin levels started reducing significantly,” said Ray.
The second challenge was to reduce propanol toxicity which was done by injecting glucagon. The patient responded well to this therapy as there was an increase in pulse rate.
The third challenge of low blood sugar levels due to high dose of insulin taken by the patient was tackled by giving Glucagon, a hormone, which interestingly is also an antidote to the other drug the patient had taken.
He was also given large doses of glucose intravenously. The total amount of IV glucose administered to our patient was 1,115 gm given over a period of 68 hours, said Dr Ray.
Finally, this unusual case of multiple drug overdose was managed successfully using specific pharmacologic therapy, hemoperfusion along with supportive measures .