Symptoms

• Burning mouth/throat or abdominal pain
• Nausea, repeated vomiting, diarrhea
• Garlic-like smell on breath or vomit
• Severe thirst, weakness
• Drowsiness, confusion, low blood sugar
• Low blood pressure, abnormal heart rhythm, collapse in severe ingestion

• Vomiting and pain may lessen, but liver injury can be progressing silently.

• Jaundice, worsening vomiting, abdominal swelling/pain
• Bleeding from gums/nose, vomiting blood, black stools, bruising
• Reduced urine output or kidney injury
• Confusion, excessive sleepiness, abnormal behavior or coma from liver failure
• Seizures, shock, multi-organ failure

What to do immediately at home / during transport

• Call emergency services or go to the nearest ER now.
• Take the container, brand name, photo, or remaining paste with you.
• If the person is unconscious, seizing, confused, or vomiting continuously, place them on their side and do not give anything by mouth.
• Do not induce vomiting.
• Do not give milk, oil/ghee, coconut oil, alcohol, or home remedies.
• Do not attempt stomach washing at home.

Hospital management

1. Stabilize ABCs: airway protection, oxygen/ventilation, IV access, cardiac monitoring, fluids and vasopressors if shock.
2. Contact a poison center/medical toxicologist early.
3. Consider activated charcoal or other gastrointestinal decontamination only under toxicology guidance, based on timing, ingestion amount, airway safety, and product formulation.
4. Avoid routine potassium permanganate lavage. Older texts describe it, but contemporary literature reports safety concerns and inconsistent evidence. It should not be used at home.
5. Obtain and repeat: CBC, glucose, electrolytes, renal function, AST/ALT, bilirubin, PT/INR, blood gas/lactate, ECG. Check liver and kidney function serially for at least 72 hours, often longer.
6. Treat hypoglycemia, vomiting, electrolyte disturbance, bleeding/coagulopathy, acute kidney injury, arrhythmias, encephalopathy, and shock.
7. If acute liver injury/failure appears, urgently transfer to a center with hepatology, ICU, and liver-transplant capability. The LTSI consensus guideline emphasizes early transplant-center evaluation, especially with worsening INR or hepatic encephalopathy. Encephalopathy of West Haven grade 2 or higher is a particularly serious transplant-listing signal.