Medicine case

CASE HSITORY AND CLINICAL FINDINGS

29 year old female patient came to the casualty with h/o consumption of rodentiscide paste / ratatol poisoning 6days back [ 10 gm - approx. containing 3% yellow phosphorus ] followed by complaits of 1 episode of fever with chills 4 days ago subscided with medication . complaints of vomiting since 4 days  2to 3 episodes per day ,food as contents complaints of  yellowish discolouration of eyes and body since yesterday associated with discolouration of urine and dcrease appetite since 2 days . patient visited to local RMP yesterday morning she under went investigations : her Hb 3.7 gmd /dl ,TB : 5.6

DB 3.2 AST 270 ,ALT 340 ,ALP 135 ,TP 6.4 ,albumin 3.9 globulin 2.5

complaints of burnung sensation in chest ,giddiness today morning associated with palpitations  so she was brought to our hospital, no history of loose stools, pain abdomen, bleeding gumsno discouluration of stools ,no h/o sob ,blood in stools ,h/o fever 7 years ago, she got tested and was told hb5  GM/dl , she used to take oral IRON tablets .on o/e pt. was ccc BP; 110/20 WIDE PULSE . PR 135 BPM REGULAR.

CVS :

Loud S1 S2 PRESENT , PARASTERNAL HEAVE PRESENT ,PANSYSTOLIC MURMUR PT IN TRICUSPID AND MITRAL AREAS,JVP ELEVATED

.R.S -

BAE present

INVESTIGATIONS

spot prot creat creat ratio -1.15, HCO3 2.4

CUE;- alb 3+

.USG SHOWS HEPATOSPLENOMEGALY

.SERUM CREATININE 0.9

UREA 26

Na: 139, K 3.8 cl  101.

PT 25,InR1.85,Aptt 50

Ph 6.9

Pco210.3

Hco3 2.5

Po2 140

So2 93

patient by nxt day afternoon became tachypneic and hypotensive- 1 unit PRBC TRASFUED ,2 FFPS TRANSFUSED , Started on ionotropic support (inj.noradrenalime and n-acetyl cystiene)

DEATH SUMMARY;-

29 YR OLD FEMALE PATIENT CAME WITH H/O CONSUMPTION OF RODENTICIDE POISON ( 5-10 GMS ) 7 DAYS AGO , FOLLOWED BY FEVER, VOMITING,AMD YELLOWISH DISCORATION OF EYES FOLOWED BY GENERALISED WEAKNESS AND DROWSINESS , BURNING CHEST. PATIENT WAS ADNITTED ALL INVESTIGATIONS NEEDED WERE SENT  PATIENT WAS FOUND TO HAVE SEVERE ANEMIA , SEVERE METABOLIC ACIDOSIS , COAGULOPATHY , ACUTE LIVER FAILURE . I/V/O SEVERE METABOLIC ACIDOSIS PATIENT WAS GIVEN INJ. NAHCO3 100 M EQ DIRECT IV, 100 MEQ IN 100 ML NS SLOW IV . PATIENT WAS STARTES ON N-ACETYL  CYSTIENE , 2 UNITS OF FFP , 10 PRBC WERE TRANSFUSED .

FEW HOURS AFTER ADMISSION PATIENT BECAME HYPOTENSIVE AND TACHYPNIC ,. STARTED ON IONOTRPIC SUPPORT ( INJ. NOR ADRENALINE) OVER NIGHT AND OTHER SUPORTIVE MEASURES WERE DONE .

ON DAY 2 OF ADMISSION PATIENT WENT INTO GASPING , PATIENT WAS INTUBATED AND CONNECTED TO MECHANICAL VENTILATION .

I/V/O PROFUSE BLEESING FRON NASAL AND ORAL CAVITY SECONDARY TO COAGULOPATHY. IMMEDIATE SUCTION ,NASAL PACKING WERE DONE. PATIENT HAD EPISODE OF SUDDEN CARDIAC ARREST AT 11;45 AM , 8 CYCLES OF CPR DONE, BUT PATIENT MOT BE REVIVED INSPITE OF ALL ABOVE EFFORTS AND DECLARED DEAD ON 12;20 PM ON 21/6/2021 AS  ECG SHOWED NO ELECTRICAL ACTIVITY.

 IMMEDIATE CAUSE OF DEATH;-

 CARDIOPULMONARY ARREST SECONDARY TO REFRACTORY METABOLIC ACIDOSIS AND REFRACTORY HYPOTENSON .

DIC, ? DIFFUSE ALVEOLAR HEAMORRAGE .

ANTECEDENT CAUSE OF DEATH;- ACUTE FULMINANT HEPATIC FAILURE  SECONDARY TO 3% YELLOW PHOSPHORUS POISONING, COAGULOPATHY , ? HEAMOLYTIC ANENIA WITH PANCYTOPENIA.