Comprehensive clinical management of acute ethephon poisoning with corrosive gastrointestinal injury and acute pancreatitis

Kalarani1*, Ancy VR2

1Nursing Incharge, Kauvery Hospital, Tirunelveli, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Tirunelveli, Tamil Nadu

*Correspondence

Abstract

Ethephon poisoning is a rare but serious medical emergency requiring early recognition and prompt multidisciplinary management. We report the case of a 24-year-old male admitted with Ethephon poisoning presenting with drowsiness and excessive salivation. Upper gastrointestinal endoscopy revealed grade IIb corrosive injury of the oesophagus and epiglottis with associated acute pancreatitis. The patient required intensive care, endotracheal intubation for airway protection, and comprehensive supportive management. He was successfully extubated, gradually resumed RT feeding through a Ryle’s tube, and was discharged in stable condition with complete recovery. This case highlights the importance of early diagnosis, airway protection, and multidisciplinary care in improving patient outcomes.

Keywords: Ethephon poisoning; Grade IIb corrosive injury; Acute pancreatitis.

Fig (1): ACS Sustainable Chemistry & Engineering, Shrodha Mondal; February 11, 2025

Introduction

Ethephon is an organophosphorus-based plant growth regulator widely used in agriculture to promote fruit ripening, flowering, and crop development. It releases ethylene, a naturally occurring plants hormone, when applied to plants. If accidently ingestion of concentrated ethephon formulations can result in serious toxic effect.  This case report comprehensive management of acute ethephon poisoning complicated by upper gastrointestinal injury and acute pancreatitis resulting in complete recovery with timely intervention and supportive care.

Case Presentation

A 24-year-old male admitted with a history of ingestion of Ethephon poison at 6:00 PM on 05.05.2026. He developed multiple episodes of vomiting and three episodes of loose stools. Initial management at a nearby hospital included gastric lavage, following which he was referred to us for further evaluation and treatment.

On admission, the patient was drowsy, arousable, obeying commands, and had excessive salivation. RT aspiration collected 50ML of blood-tinged fluid.  Initial treatment included anticholinergic therapy, pralidoxime infusion, intravenous fluids, antibiotics, and other supportive medications.

Clinical Examination

  • Pulse Rate: 60–120 beats/min
  • Blood Pressure: 130/80 mmHg
  • SpO₂: 100% on room air
  • Cardiovascular System: S1 and S2 heard normally
  • Respiratory System: Bilateral air entry present, no added sounds
  • Abdomen: Soft
  • ABG: pH 7.30, pCO2: 29mmHg, pO2: 84mmHg, HCO3 14, Lactate: 0.9mmol/L
  • Capillary Blood Glucose: 180mg/dl
  • Bilateral pupils: 3mm, reactive
  • Unable to perform neck holding.

Endotracheal intubation was done by causality due to threatened airway, hyper salivation bradycardia. Mechanical ventilation initiated. Intravenous fluid initiated.

Intensive Medical Care Unit (IMCU) Management

On 06.05.2026, Patient shifted to the Intensive Medical Care Unit (IMCU) with following infusion. In view of patient condition. Gastrology opinion obtained advised UGI Scopy

Investigation Cholinesterase: 198.00U/L

Upper Gastrointestinal Endoscopy (06.05.2026)

  • Grade IIB corrosive injury of the oesophagus.
  • Severe injury involving the aryepiglottic fold and posterior border of the tongue.
  • Features suggestive of acute pancreatitis.

Echocardiography (06.05.2026)

  • Normal left ventricular systolic and diastolic function.

Ultrasonography Abdomen (07.05.2026)

  • Bilateral mild pleural effusion.
  • Gaseous bowel loops.

The patient remained hemodynamically stable throughout the ICU stay. On 10.05.2026, he was successfully extubated and the patient was shifted to the ward on 12.05.2026. All Lab reports are normal.

DateInvestigation namePatient ValueNormal Value
06.05.2026Cholinesterase198.00 U/L3830-10800
07.05.2026Cholinesterase1139.31 U/L3830-10800
pH blood7.417.37-7.45
Total Bilirubin1.11mg/dL0.1-1.2
08.05.2026Cholinesterase1350.75 U/L3830-10800
09.05.2026Cholinesterase2020.17 U/L3830-10800
WBC9260 cells/Cumm4000-11000
POCT Normal

Ward Management

He remained clinically stable with normal vital signs. Nutritional support and medical management were continued, and his condition improved steadily. He was discharged on 14.05.2026 in stable condition with advice for regular follow-up

Treatment

  • Piperacillin–Tazobactam (Piptaz) 4.5 g TDS
  • Solu-Medrol 40 mg OD
  • Pralidoxime (PAM) 1 g TDS
  • Emeset 8 mg BD
  • Pantoprazole 40 mg BD
  • Syr Potassium Chloride 15 mL TDS
  • Nebulization with Duolin TDS
  • Intravenous fluids and supportive car

Outcome

The patient showed gradual clinical improvement with Atropine, Pralidoxime, Mechanical ventilation and supportive care. Bradycardia and excessive salivation resolved and the patient hemodynamically stable. The patient was successfully weaned from mechanical ventilation and extubated. Oral feeding was started without difficulty. He recovered successfully and discharged.

Nursing Management

With timely nursing management, continuous monitoring, airway management, medication administration, and supportive care the patient’s condition improved gradually. The patient remained stable, recovered well and was discharged successfully.

Discharge

He was clinically stable with normal vital signs. Were educated to the patient and family on medication adherence, adequate hydration, and warning signs such as breathing difficulty, excessive salivation, vomiting, weakness, or altered consciousness that require immediate medical attention. They were advised to avoid further exposure to chemicals, attend scheduled follow up visits, and continue prescribed medication as directed.

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