Blue lips, coma and haemolysis

• Copper sulfate is a blue, odourless substance found in a variety of pesticides, chemistry sets, classrooms and crystal gardens. • Copper sulfate, when ingested, can cause local necrosis of the gastrointestinal tract, and a range of systemic effects, including coma, haemolytic anaemia, centrilobular necrosis of the liver and tubular necrosis. • Ingestion of copper sulfate, although tare, is easily identified, as the patient often complains of a metallic taste, epigastric burning and nausea, and has blue-green vomitus and blue stools. • Management should be concerned with identifying local damage and monitoring systemic effects for several days, as toxicity might not necessarily be evident on initial presentation.