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Paper text:
ammonium dichromate is an odorless , bright orange to red , crystalline powder used in pyrotechnics , fireworks , photography , and in dyes used for screen and color printing .
skin manifestations after industrial exposure of chromate salts are well - known , but little is known about systemic toxicity and its treatment .
a 25-year - old female patient presented with history of vomiting and oliguria for 10 days .
patient had taken a handful of orange red crystals with suicidal intent 10 days earlier while working in a printing press [ figure 1 ] .
she was taken to a local hospital where stomach wash was given and managed conservatively .
ammonium dichromate crystals on examination , patient was dehydrated with blood pressure of 130/80 mm of hg and pulse of 98/min .
her investigations showed hemoglobin 7.2 g / dl , urea 650 mg / dl , creatinine 19 mg / dl , sodium 122 meq / l , potassium 7.9 meq / l , calcium 6.7 mg / dl , phosphorus 5.6 mg / dl , bilirubin 0.8 mg / dl , albumin 4.1 g / dl , total protein 7.2 g / dl , alanine transaminase 28 iu / l , aspartate transaminase 106
iu / l , alkaline phosphatase 66 iu / l , lactate dehydrogenase 124 iu / l , and creatine kinase 67
her arterial blood gas analysis showed severe metabolic acidosis with ph of 7.01 , pco2of 23 mm of hg and bicarbonate of 6 meq / l .
her electrocardiogram showed tall peaked t waves with prolongation of pr interval and qrs duration .
patient urine output improved gradually and she was discharged with creatinine of 1.3 mg / dl . her serum creatinine during the last follow - up was 1.1 mg / dl .
hexavalent chromium salts have been recognized as occupational health hazards for more than two centuries .
chromium compounds can exist in a variety of valence states , of which chromium ( iii ) appears to be the most stable and important form .
chromium ( iii ) will form stable organic complexes with proteins , and amino acids .
being a strong corrosive agent , dermal contact with chromium ( vi ) compounds can cause allergic dermatitis or sensitization .
after ingestion , ammonium dichromate causes corrosive injury to the oral mucosa , esophagus , and stomach .
the systemic manifestations include intravascular hemolysis , acute respiratory distress syndrome , toxic hepatitis , acute kidney injury , thrombocytopenia , and encephalopathy .
chemical analysis of the stomach aspirate is often not useful as ammonium dichromate is highly dissociable compound .
various treatment modalities tried are exchange transfusion , ascorbic acid , n - acetylcysteine , chelation with dimercaprol and dialysis .
ascorbic acid has reducing property and in large doses accelerates the rate of reduction of chromium vi to chromium iii leading to the formation of chromium protein complex , which is nontoxic and excreted in the urine . though exact dose and duration of ascorbic acid is not known , large doses of ascorbic acid ( 1 g ) has been successfully used to prevent renal failure .
hemodialysis can effectively remove chromium ( vi ) though the reports on its efficacy in clinical settings are conflicting .
meert et al . , report the death of a child following a 1 g ingestion of ammonium dichromate .
hassan reported a case of 24-year - old female who presented with multiorgan failure after ammonium dichromate ingestion .
she was treated with hemodialysis and ascorbic acid ( 500 mg / day ) after which she improved .
the cause of renal failure in our patient is probably acute tubular necrosis secondary to both emesis related hypovolemia and direct tubular toxicity of chromium compound .
renal biopsy was not done as her urine output started improving during 2 week of admission .
our patient presented 10 days after the ingestion with severe renal failure without features of any other organ involvement .
since she presented very late , we did not treat her with ascorbic acid and chelating agents .
screen - printing and coloring work is becoming more and more popular in india and the availability of these compounds is much easier now .
the health care professionals should be aware of the manifestations of chromate poisoning and benefits of early management , especially with large doses of ascorbic acid .
ammonium dichromate is an inorganic compound frequently used in screen and color printing . 
 being a strong oxidizing agent , it causes oxygen free radical injury resulting in organ failure . 
 we report a 25-year - old female who presented with acute kidney injury after consumption of ammonium dichromate . 
 she was managed successfully with hemodialysis and supportive measures . 
 this case is reported to highlight the toxicity of ammonium dichromate .