Case presentation of organophosphorus

1. •
‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
•
‫اشراف‬ ‫تحت‬
•
‫ا‬
.
‫د‬
/
‫زين‬ ‫محمد‬
.
‫باسيوط‬ ‫الصحة‬ ‫وزارة‬ ‫وكيل‬
•
‫د‬
/
‫جمال‬ ‫محمد‬
.
‫باسيوط‬ ‫العام‬ ‫االيمان‬ ‫مستشفي‬ ‫مدير‬
.
‫لسيادتكم‬ ‫مقدمة‬
:
‫د‬
/
‫مكرم‬ ‫بيشوي‬
.
‫المركزة‬ ‫الرعاية‬ ‫نائب‬
.
‫العام‬ ‫االيمان‬ ‫مستشفي‬

2. Organophosphorus poisoning
case
Clinical approach and management

3. •
Male patient42 years old admitted to the emergency room on 6/10/2022.
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Past history : free past medical history ,pt not known d.m or htn ,no history of previous
admission or surgeries.
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Clinical presentation :pt presented dcl GCS:9/15,shocked and desaturated
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History :
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History from his family they claimed that he ingest (insecticide by mistake) and few minutes
later he suddenly begin to be confused,drowsy and later loss of consciousness .
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Examination: pinpoint pupil
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Bilateral basal crepetations by auscultation.
Patient
Presentation

4. •
Blood pressure 80/40
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Pulse :120 /min, regular,weak,equal on both sides.
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Temp :36.5
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Respiratory rate :30/min
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Oxygen saturation :85% on room air.
Vital signs

5. Investigations
Imaging
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Chest x-ray was done on admission : show aspiration confirmed by c.t chest.
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Ekg : sinus tachy

6. Labs on admission
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Cbc :
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Hb :12.5 mg/dl , Tlc : 6.8 , Lymph : 2 , Plt :167
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S urea : 44 mg /dl S creatinine :1.1 mg/dl
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Ast : 34 Alt : 11 Albumin :3.2 g/dl
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Protein 5.5 INR : 1.13 Prothrombin time :13.3
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Na :138 , K :3.7.
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ABG on admission on RA : PH: 7.30 , Pco2 : 55 , Po2 : 65 , Hco3 : 24

7. Management
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1-first goal in management is to prevent further exposure to the poisoning by
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- carefully removing pt clothes and deliver it to the authority.
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-gasric lavage was done and sent to forensic science lap for test.
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2-ABC protocol :airway management,breathing (oxygen theraby) and circulatory support by
inotropes.
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3-atropine injection.
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4-PAM injection.

8. Pharmacological treatment
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1- antibiotics Ceftriaxone 2g IV /24 hours

9. Progression 1
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On day 2 of admission :
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The pt show progress in oxygenation , descalating to Ventury 40 and oxygen
saturation is 97 % ,improvement of conscious level.
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ABG : PH: 7.41, PCO2 : 35, PO2 : 68 , HCO3 : 22
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Good urine output : 50 – 100 ml / h
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Vital signs:

10. Progression 2
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On day 4 of admission :
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The pt is much more improve , descalating oxygen to ventury 24 and oxygen saturation 94
% .
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pt continue prone position .
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we start chest physiotherapy .
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Investigations : ABG accepted , S creatine : 1.3 , Urea : 50
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Vital signs are stable , good urine output , investiagations accepted .
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Follow up Ct chest was done : improved
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Treatment : desclating steroids , continue other medications .

11. Progression 3
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On day 6 on admission
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Pt is now on simple oxygen mask and oxygen saturation 95%.
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Not dyspnea or tachypnea , no fever .
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Vital signs normal . Good urine output .
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Investigations : D dimer : 0.3 , S ferritin : 250 , S creatinine :1.2 , Urea : 44 .
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Treatment: descalating antibiotics , continue other medications .
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Pt was discharged to ward and discharged home after 2 more days