mr-organophosphate poisoning
DESCRIPTION
poisoning description and its managementTRANSCRIPT
MORNING CASE REPORTMonday, 30 November 2015
Patient Identity Name : WSD Sex : Female Age : 22 y.o. Religion : Hinduism Occupation : Bank employee Address : Jl. Tukad Pakerisan, Denpasar DoA : Nov 27th , 2015 ToA : 16.41
Anamnesis
Chief Complaint: weakness History of Present Illness: Patient was admitted to Emergency department of
RSUP Sanglah after her kost-mate discovered her within her room in weak condition 30 minutes BATH.
Patient experienced weakness following ingestion of 1 mosquito coil (“obat nyamuk bakar”) which was done purposely.
During her transport to the hospital, she vomited once with an estimated volume of 100 ml. The vomitus contains mosquito repellent residue, previously consumed food, along with water.
Patient denied headache and breathlessness.
Past HistoryPatient had committed similar suicide
attempt in 2012.History of psychiatric disorder; diabetes;
kidney, heart and liver disease; altogether with asthma was denied.
Family HistoryThere are no known relatives who possess a
history of psychiatric disorder.History of diabetes; kidney, heart and liver
disease; as well asthma was also denied.
Patient works as a bank employee. She had an intense argument with her
spouse prior to attempting suicide. Patient ordinarily consumes alcohol to
overcome her problems. She had roughly about 2-3 glasses in a course of a month. Smoking and coffee consumption was denied.
Physical Examination General Condition : moderately illGCS : E4V5M6BP : 110/70 mmHgRR : 20 x/minsPR : 84 x/minsTax : 36,70 CWeight : 60 kgHeight : 156 cmBMI : 24,6 kg/m2
Eye : an -/-, ikt -/-, Rp +/+ isokor, swollen eyelid -/-
ENT : Hyperemic pharynx (-), secretion (-) Neck : JVP PR ± 0 cm H2O
Lymph node enlargement (-) Thorax :
Cor : I : IC Unseen Pal : IC palpable at ICS V MCL Sinistra Per : RB : PSL Dextra
LB : MCL Sinistra UB: ICS II
Aus: S1S2 single, regular, murmur(-)
Po : I : Symmetrical (+) (static & dynamic)
Pa : Vocal Fremitus N/N Per : sonor /sonor A : Ves +/+, Rh -/- , Wh -/-
Abdomen : I : Dist (-) Aus : BU (+) NPa : H/L unpalpablePe : Tympanic (+)
Extremeties : Warm + + Edema - -
+ + - -
Complete Blood CountParameter
Result Verdicts Reference range
WBC 8,91 4.1-11.0
Ne 57,7 % (5,14) 47-80% (2.5-7.5)
Lym 29,8 % (2,66) 13-40% (1-4)
Mo 7,03 % (0,626) 2-11%(0.1-1.2)
Eo 3,92 % (0,349 0-5%(0-0.5)
Ba 1,53% (0,137) 0-2%(0-1)
RBC 5,30 106 /uL 4-5.2 106
HGB 14,2 g/dL 13,50-17,50
HCT 45,9 41-53
MCV 86,6 80-100
MCH 26,8 26-34
MCHC 30,9 31-36
RDW 12,0 11,60-14,80
PLT 294 140-440
MPV 6,89 6,80-10,00
Blood Chemistry Parameter Result Verdicts Reference
range
SGOT 18 11-33
SGPT 13,8 11-50
BUN 8 8-23
SC 0,85 0,70-1,20
GDS 95 70-140
Assessment Tentamen suicide (suicide attempt) with Organophosphate.
TherapyHospitalized.IVFD NaCl 0.9% 20 drops/minute.NGT: Gastric lavage with 200 cc water (till
clear)Norit 5 tab.Psychiatry department referral.
Monitoring Monitoring Vital sign (BP, RR, HR). Complaints.
Psychiatric Diagnosis
Axis 1 : Deliberate self-poisoning with chemical substance (“Peracunan Diri Dengan Sengaja Dengan Menggunakan Zat Kimia”)
Axis II : Unstable emotional personality disorder – Impulsive Type (“Gangguan Kepribadian Emosional Tidak Stabil Tipe Impulsif”)
Axis III : Organophosphate Intoxication (“Intoksikasi Organofosfat”)
Axis IV : known stressor : debt problemsAxis V : GAF 20-11
Therapy: Clobazam 1 x 10 mg