A housewife ingests a rodenticide white powder accidentally. She is brought to hospital where the examination shows generalized, flaccid paralysis and an irregular pulse. ECG shows multiple ventricular ectopics, generalized changes with ST. Serum potassium is 2.5 mE/1. The most likely ingested poison is –

## **Core Concept**
The question tests the understanding of poisoning with specific rodenticides and their clinical manifestations. The key concept here involves recognizing the symptoms and laboratory findings associated with poisoning by certain chemicals, particularly those causing hypokalemia and cardiac arrhythmias.

## **Why the Correct Answer is Right**
The correct answer, **B.**, refers to the poisoning by a rodenticide that contains **Barium** or more specifically, **Barium carbonate** or **Barium sulfate**, though the latter is less toxic. Barium poisoning leads to **hypokalemia** (low potassium levels) due to the inhibition of the Na+/K+ ATPase pump in the kidneys, causing potassium loss. The symptoms presented - generalized flaccid paralysis, irregular pulse, multiple ventricular ectopics on ECG, and generalized ST changes - are consistent with severe hypokalemia and cardiac toxicity. The mechanism involves barium's interference with potassium channels and pumps, leading to a significant drop in serum potassium.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option does not correspond to a commonly recognized rodenticide associated with the described symptoms.
- **Option C:** While certain rodenticides can cause coagulopathy or direct toxicity, **C.** does not directly align with the acute presentation of hypokalemia and cardiac arrhythmias described.
- **Option D:** This option does not match a well-known cause of the specific constellation of symptoms and lab findings presented.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **barium poisoning** is a classic cause of **severe hypokalemia**. Patients with barium poisoning often present with muscle weakness or paralysis, cardiac arrhythmias, and ECG changes due to the low potassium levels. Rapid recognition and treatment of hypokalemia, along with supportive care, are crucial.

## **Correct Answer:** B.

✓ Correct Answer: A. Barium carbonate