Crayola toxicology: life-threatening causes of bluish vomiting

November 14, 2014, 12:08 am


 Bluish vomiting: a rare clinical presentation of poisoning. Higny J et al. Acta Clin Belg 2014;69:299-301.


This case report describes a 65-year-old man who ingested an unknown substance and subsequently present with pharyngitis and mucositis, nausea, diarrhea, abdominal pain, and blue-green vomitus. The remainder of the physical exam and basic laboratory results were unremarkable.

The authors use the case to discuss 3 life-threatening ingestions that can cause bluish emesis. Unfortunately, their discussion of these causes is confusing and superficial. And, of course, must blue green vomitus will be due to food dye, blue raspberry Gatorade, or some other benign but brightly colored substance.

This article does serve to remind us of 3 important not-to-miss ingestions on the differential when a patient shows up barfing blue. Unfortunately, the authors misses an obvious mnemonic: Cerulean Blue Puke = Copper sulfate, Boric acid, Paraquat.

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