we present an unusual case of a 24 year old male who was hospitalized to undergo a dental procedure and subsequently developed a cardiac arrest 2 days following the procedure .
the patient presented with a swelling in the buccal cavity for which a biopsy was taken .
two days following the procedure , the patient suddenly presented at night with recurrent ventricular tachycardia ( vt ) and fibrillation ( vf ) , which were intractable requiring multiple dc shocks . during this period arterial blood gas analysis revealed severe metabolic acidosis .
electrocardiogram ( ecg ) revealed vt / vf [ figure 1 ] . following termination of vt ,
subsequently detailed history from the wife revealed that the patient had a heated argument with his wife , after which he was not seen in bed for 2 - 3 hours .
2 hours later , patient was found to be unresponsive and cardiac arrhythmias were noted .
electrocardiogram showing ventricular tachycardia electrocardiogram showing deep t - inversions in precordial leads following termination of the arrhythmia the circumstances led us to suspect poisoning as one of the cause for his medical condition .
patient had access to hand sanitizers which was freely available in the hospital attached to the walls .
the constituents of hand sanitizer include isopropyl alcohol ( ipa ) , glycerin and perfume .
his gastric lavage sample was analyzed by head space gas chromatography- mass spectroscopy , which revealed the presence of ipa .
patient remained hemodynamically stable for the next 9 days although his conscious level did not improve .
when it does occur in the young , it is important to consider poisoning or toxic ingestion as one of the causes .
centre of disease control endorses the use of alcohol based hand sanitizers to prevent pathogen transmission . in a few case reports , a prisoner and a hospitalized patient had consumed ethanol based sanitizer .
they underwent conservative management and recovered . a few cases with intoxication due to ipa based sanitizers have been reported.[35 ] these patients underwent aggressive hemodialysis and had an uneventful recovery . in our patient
we could reverse the toxic effects of ipa with hemodialysis but due to intractable arrhythmias patient had sustained hypoxic ischemic encephalopathy and later succumbed to sepsis .
healthcare professionals need to be aware of common toxins which are accessible to patients in the hospital setting .
we recommend to use a caution in bold letters  may cause death if ingested  on the label of the container .
inhalation and ingestion of ipa at high concentration leads to apnea , cns depression with subsequent coma and death .
treatment of ipa poisoning should include decontamination by activated charcoal ; supportive care is required for hypotension and respiratory depression .
this case summarizes the need to educate healthcare professionals regarding the toxic effects of commonly available sanitary products in the hospital with a protocol to manage the same when it does occur .
 we present an unusual case of 24 year old male who was hospitalized for dental procedure and developed cardiac arrest 2 days after the procedure . 
 the patient presented with swelling of buccal cavity for which a biopsy was taken . 
 two days after the procedure , apparently normal patient suddenly presented at mid night with vt and vf , which were intractable requiring multiple dc shocks . during this period arterial blood gas analysis revealed severe acidosis . 
 the circumstances led us to suspect poisoning as one of the cause for his medical condition . 
 we looked for commonly available toxins . 
 one of the commonly available toxins is hand sanitizer which contains isopropyl alcohol , glycerin and perfume . due to prolonged cardiac arrest and 
 intractable arrhythmia patient had sustained hypoxic brain injury . 
 patient remained hemodynamically stable for next 9 days although his cns status did not improve . 
 patient succumbed to sepsis on 9th day . 
 healthcare professionals should be aware of such possibilities and treat the patients at the earliest and put a check on the easy availability of ipa based hand sanitizers . 
INTRODUCTION
DISCUSSION