29 /F WITH YELLOW PHOSPHORUS POISONING

 Unit 5 admission : 

Duty pgs :  DR K VAISHNAVI

DR CHANDANA 

29 year old female patient came to casualty with history of alleged consumption of rodenticide paste /ratatol  poisoning six days back.  (10 gms - approx ,containing 3% yellow phosphorus) ) followed by complaints of fever with chills 1 episode, 4 days ago subsided with medication

c/ of vomitings since 4 days to 2-3 episodes per day ,food as content 

complaints of yellowish discoloration of eyes and body since yesterday associated with discolorationn of urine and decreased appetite since 2 days 

patient visited local RMP is yesterday morning,she underwent few investigations her hb :3.7,TB 5.6,DB 3.2,AST 270,ALT 340,ALP 135,TP 6.4,Alb 3.9,Glb 2.5

complaints of burning sensation in chest Guiddiness today morning associated with palpitations, so they brought her to our hospital No history of loose stools ,pain abdomen, bleeding gums

no discoloration of stool 

no history of shortness of breath, blood in stools 

history of fever seven years ago ,she got tested and was told to have HB of 5 but no history of blood transfusions ,she used to take oral iron tablets.

O/E : Pt c/c/c

Bp- 110/20 mmhg (  Wide pulse pressure ) 

Pr - 135 bpm , regular 

Cvs - Loud S1 S2 present .

parasternal Heave present .pansystolic murmur present in tricuspid and mitral areas. 

Jvp elevated.

RS - BAE present. ,clear .

spo2- 88-92 % on room air and 98% on 4 lit of oxygen. 

Hb - 4.1 ,Tlc -3000 , platelets - 90,000

Pt - 25 ,INR - 1.85 ,APTT - 50 sec .

ph -6.99 ,pco2 - 10.3 , po2- 142 , spo2 - 93.2 

hco3 - 2.4 

spot prot creat ratio -1.15 

cue - alb - 3+

Diagnosis - Acute liver failure secondary to yellow phosphorus posining ( rodenticide /ratatol) .

With coagulopathy. 

Severe metabolic acidosis (HAGMA) 

pancytopenia under evaluation . 

USG showing mild hepatospleenomegaly

Serum creatinine 0.9

Urea 26

Na 139

K 3.8

Cl 101

Patient by yesterday afternoon became tachypneic and hypotensive

1 unit PRBC transfused

2 FFPs transfused

Started on inotropic support(Inj nor ad) and

N acetyl cystiene