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Objective: Cartap hydrochloride poisoning is an uncommon poisoning encountered in India. The aim of this study was to assess the characteristics, severity, management, and outcome of patients with Cartap poisoning, treated with N-acetylcysteine (NAC) in intensive care unit (ICU) of a tertiary referral hospital.Methods: This is a retrospective study where 11 cases of Cartap poisoning admitted to hospital ICU between 2011 and 2016 were identified from the case records. The demographic data, mode of ingestion, time to treat, ingested dose and severity of poisoning, presenting features, duration of mechanical ventilation (MV), dose of NAC used, complications, and outcome were noted.Results: Patients were scored as moderate or severe cases of poisoning. Severe cases consumed >10 g, underwent gastric lavage > 4 hrs, and took Cartap concomitantly with alcohol or in empty stomach. Duration of MV varied from 68-94 hrs in severe cases and 12-48 hrs in moderate cases. Average dose of NAC in severe case was 11.19 g and moderate case was 8.89 g. The most common presenting symptoms were vomiting, altered sensorium, and breathlessness. Severe cases had more complications, and the most common complication was hypotension followed by seizures. Survival was 100%.Conclusion: 50% of Cartap poisoning cases had good survival outcome. Severity of poisoning depends on amount of Cartap ingested, time taken for gastric lavage, and concomitant administration of alcohol. Duration of MV and dose of NAC and complications encountered correlates with the severity of poisoning.

Objective: Endogenous production of glutamine may be reduced during critical illness. The shortage of glutamine is reflected as a decrease in plasma concentration, which is a prognostic factor for outcome in sepsis. Therefore, we have studied the effect of enteral or parenteral glutamine therapy on biochemical parameters and the hospital stay of critically ill patients.Methods: A total of 66 critically ill patients aged 18-70 years, admitted to central and medical intensive care unit of a tertiary care hospital were randomly divided into three equal groups; 22 in each group: Group 1 (control group) received no glutamine, Group 2 received oral glutamine 0.5 g/kg/d for 5 days, and Group 3 received parenteral glutamine 0.5 g/kg/d by intravenous infusion for 5 days. All patients received glutamine-free tube feed throughout the study period. Total leukocyte count (TLC), total lymphocyte count, total protein and serum albumin, serum lactate, and sequential organ failure assessment (SOFA) score were recorded on each day for 7 days and were compared.Results: Decrease in the TLC and increase in lymphocyte count was most evident in Group 3 compared to Groups 2 and 1 which was statistically significant. Decrease in serum lactate and increase in serum protein and albumin was maximum in Group 3 compared to Groups 1 and 2 which was statistically significant. The mean duration of hospital stay of Group 3 was the least followed by Groups 2 and 1 which was statistically not significant. There was an improvement in SOFA score in all the three groups.Conclusion: Parenteral glutamine in a dose of 0.5 g/kg/d was more potent than oral glutamine in improving the biochemical parameters. The duration of hospital stay was similar in all the groups after treatment.