30YR OLD FEMALE WITH RODENTICIDE CONSUMPTION (? Yellow phosphorus)

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box



30 yr female came to casuality with c/o consumption of rat poison (RATOL PASTE ? YELLOW PHOSPHORUS -1 full tube approx 15g, 2 weeks ago)

DAY 2 - VOMITINGS 3- 5 EPISODES (food as contents) and diarrhea episodes for 24 hours.

DAY 3 - vomitings subsided but developed yellowish discoloration of eyes

DAY 6 - Developed PEDAL EDEMA and Shortness of breath (SOB of sudden onset , progressive) 

DAY 7 was admitted at local hospital outside

DAY 10 Constipation and decreased urine output  

DAY 12 was brought to our hospital with no urine output since one day , in irritable condition.

Past history:

No H/O  DM, HTN, CAD, Asthma , previous liver disease .


General Examination: 

 Patient was concious , coherent and cooperative and oriented to time place and person 

Patient was irritable 

Temp- 98.6 F



BP- 120/80 mmhg

PR- 78 bpm

RR- 18 cpm

SpO2- 97% at 8lit o2



No pallor

Icterus present



No cyanosis, clubbing, lymphadenopathy

Mild pedal edema is seen 




Systemic Examination:

CVS- S1 S2 +,no murmurs

CNS- Patient is irritable 

RS- BAE+, reduced breath sounds in b/l IAA , ISA

P/A- Distended, Petechial rashes +, tense 


Distended abdomen:





 Petechial rashes: 

Urine bag



Investigations: 

Hemogram 

Liver function tests

Radiological findings:

ECG:

X-ray - bedside 

Planned for PLEURAL and ASCITIC TAP

Provisional diagnosis: 

? YELLOW PHOSPHORUS POISONING with ACUTE LIVER FAILURE and ACUTE LUNG INJURY (PLEURAL EFFUSION) 



Treatmemt:

Ivf NS,RL,DNS @UO+30ml/hr

Inj.OPTINEURON 1 amp in 100ml NS IV OD

Inj.Vit K 10mg IV OD slow iv

Inj.PAN 40mg iv od

Inj.ZOFER 4mg IV BD

Syp.LACTULOSE 20ml PO H/S

Inj.NAC 6000mg in 500 NS over 4hrs , f/b 2000mg in 500ml NS over 8hrs,  f/b 400mg in 500ml NS over 16hrs

Inj.MONOCEF 1gm IV bd

Syp.LIV 52 10ml po bd

Ivf dns with 8U HAI IV stat over 3 hrs.

Inj. Dexmedetomidine 1amp + 49 ml NS @5ml/hr 

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