17 YR FEMALE WITH RAT POISON INTAKE
17 YR FEMALE WITH RAT POISON INTAKE
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A 17 year female came to casualty with active seizures and history of intake of rat poison 11 days ago.
HISTORY OF PRESENTING ILLNESS
History of intake of rat poison powder followed by two episodes of vomitings with food as contents and yellowish discoloration of eyes.
History of generalized seizures with the 2-5 episodes for past since 11 days
PAST HISTORY -
NOT A KNOWN CASE OF HTN, DM , EPILEPSY , ASTHMA , TB
PERSONAL HISTORY :
DIET - MIXED
APPETITE -NORMAL ,
BOWEL MOVEMENT - REGULAR ,
BLADDER MOVEMENTS - REGULAR, ADDICTIONS(ALCOHOL AND SMOKING) - NO ADDICTIONS
FAMILY HISTORY -
NAD
ON EXAMINATION -
PATIENT IS CONCIOUS , COHERENT COOPERATIVE
NO PALOR, ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA
VITALS -
TEMPERATURE - 98.1
PULSE RATE - 89 BPM
BLOOD PRESSURE - 140/90 MM OF HG
RESPIRATORY RATE - 18
SPO2 - 99 % AT ROOM AIR
SYSTEMIC EXAMINATION -
CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
CENTRAL NERVOUS SYSTEM : NAD
INVESTIGATION
DAY 1
PT - 15sec
INR - 1.5
Day 2
Day 6
Day 11
TREATMENT P
INJ. LORAZEPAM 2ML IV
INJ. LEVIPIL 1G IV
IVF NS @ 75 ML/HR
INJ. PAN 40 MG IV OD
INJ. PHENYTOIN 20MG/KG IV STAT
F/B 100MG TID
INJ. N-ACETYL CYATEINE 150MG/KG IN 200 ML IN 5DW IN 30 MIN
F/B 50MG/KG IN 500 ML 5DW IN 4HRS
F/B 100MG/KG IN 1000ML OF 5DW IN 16HRS
SOAP NOTES DAY 1, 8PM
S:
6 episodes of seizure like activity (psudoseizure) since morning
No fever spikes
Not passed stools
No tongue bite,
No bleeding manifestations
O
ON EXAMINATION -
PATIENT IS drowsy, arousable
GCS - E4 V5 M6
NO PALOR, ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA
VITALS -
TEMPERATURE - 98.1
PULSE RATE - 90 BPM
BLOOD PRESSURE - 100/60 MM OF HG
RESPIRATORY RATE - 18
SPO2 - 99 % AT ROOM AIR
SYSTEMIC EXAMINATION -
CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
CENTRAL NERVOUS SYSTEM : NAD
A
Seizures secondary to ?toxin induced encephalopathy
P
INJ. LORAZEPAM 2ML IV
Inj. Sodium valproate 600mg IV BD IN 100ML NS over 30 mins
INJ. LEVIPIL 1G IV
IVF NS @ 75 ML/HR
Inj. Optineuron 1amp in 100ml ns IV OD
INJ. PAN 40 MG IV OD
INJ. PHENYTOIN 20MG/KG IV STAT
F/B 100MG TID
INJ. N-ACETYL CYATEINE 100MG/KG IN 1000ML OF 5DW IN 16HRS
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