A 70-year-old male presented with shortness of breath after consuming insecticide. He had a history of hypertension. On examination, he was drowsy with low oxygen levels and elevated vitals. Lab investigations showed low hemoglobin and elevated inflammatory markers. He was diagnosed with insecticide poisoning, methamoglobinemia, and acute DVT. He received gastric lavage, intubation, antibiotics, antidotes, and anticoagulants. His condition gradually improved and he was extubated and started on regular medications for a week before being discharged. Monitoring for bleeding was needed due to concomitant use of anticoagulants.

1. A CASE STUDY ON INSECTICIDE POISONING
PRESENTED BY :
Shaik Shaheera
III PHARM D
19AB1T0024.
UNDER THE GUIDANCE OF : Mr. Sateesh
.S. Gottipati
B.PHARM.,M.S(USA),CIP(USA)
Associate professor
Dean of academics and chief
Preceptor
Department of pharmacy practice.
VIGNAN PHARMACY COLLEGE
(Approved by AICTE, PCI-New Delhi and affiliated to JNTUK)
Vadlamudi, Guntur (dist), pin.code: 522213

2. NAME: XXXX
GENDER: male
AGE: 70
ADM DT: 7-4-2022[06:30 PM]
UMR NO: GN-220400394
IP NO: IPGN220400144
PAIENT DETAILS-

3. SUBJECTIVE-
C/O- Shortness of breath due to consumption of insecticide at 9:00 AM on 7-4-2022.
Triage level II.
Patient was drowsy.

4. OBJECTIVE-
PAST MEDICAL HISTORY: Hypertension.
PAST MEDICATION HISTORY: On regular hypertensives.
VITALS: BP-130/90
SPO2: 78%
TEMPERATURE: 101 F
PR: 102 bpm
GRBS: 147 mg/dl.
PHYSICAL EXAMINATION: pupil- PERL
Restraint- present
IV line- peripheral
bowel sound- opened
peripheral pulse- palpable.

5. LAB INVESTIGATIONS:
PARAMETER RESULT REFERENCE
Hb 7.3 g/dl 12-15 g/dl
Total WBC 21,100 cells/mm3 4000-11,000 cells/mm3
Total RBC 2.28 million cells/mm3 3.8-4.8 million cells/mm3
Packed cell volume 23% 37-49%
Mean cell volume 13.3 pg 27-32 pg
Absolute lymphocyte count 4420 cells/mm3 1000-3000 cells/mm3
Neutrophills 71% 55-76%
Serum LDH 989 U/L 120-246 U/L
CPK 1487 U/L 35-170 U/L
CRP 19.4 mg/L on 8-4-22
17.6 mg/L on 9-4-22
<10 mg/L
INR 0.99 Normal- 0.8-1.2
On std therapy- 2.0-3.0
0n high dose therapy- 3.0-
4.5
Prothrombin time 24.62 sec 18-32 sec.

6. VENOUS DOPPLER: of both lower limbs
ON 10-4-22 mild atheromatous changes in bilateral lower limbs with significant stenosis.
ON 18-4-22 as compared to the previous doppler[10-4-22] NO C/O Of DVT/Superficial thrombophlebitis.
GENERAL REGULAR DIAGNOSIS:
ON 7-4-22 compensated mild metabolic acidosis.
mild renal failure.
ON 18-4-22 ORGANOCHLORIDE INSECTICIDE POISIONING.
[INDAXICARB 14.5%,ACETAMPRID 7.7%]
with methamoglobulinemia with hypoxia,
mild renal failure,
frequent episodes of AF,
acute DVT involving RT superficial femoral & popletial veins.
gastric lavage was done.
INTUBATED ON 7-4-22.
EXTUBATED ON 9-4-22.
CARD,Psychiatry reference done.
Holter monitoring for 48 hrs done.
IPRBC transfusion done.
ON ryles tube insertion.
Fole’s catheterization.
rescusitation.

7. ASSESMENT-
A 70 years old male patient who is hypertensive and non-diabetic has presented with c/o shortness of
breath , fever , drowsiness due to the consumption of insecticide and advised on admission for emergency
treatment (Triage -2-red within 15 mins).

8. PLAN-
STAT,SOS ,PRE ANAESTIC MEDICATION AT TRIAGE AREA ON 7/4/22.
DRUG DOSE ROA FREQUENCY CATEGORY
INJ PANTOP 40 mg iv stat Protein pump
inhibitor
INJ MONOCEF 1gm iv stat antibiotic
INJ N-ACETYL
CYSTIENE
1.2gm/100ml ns iv stat mucolytic
INJ EMCET 4mg iv stat Anti emetic
INJ VIT K 10mg iv stat coagulant

9. Inj fentanyl 50 mcg IV STAT SYNTHETIC OVER
DOSE
Inj rocuronium 50mg IV STAT Neuromuscular
blocker
Inf NS 200ml
100ml
IV BOULS
CONTINUOUS
NUTRIENT
SUPPLEMENT
Inj paracetamol 1gm IV STAT NSAID
Methylene blue 75mg IN 100ml NS IV once in 30 mins STAT EMERGENCY
TREATMENT[DYE]
Inj NaHCO3 15ml IV STAT OVER 5 TIMES ANTACID

10. 0n 11-4-22
Inj magnex forte 3gm iv stat antibiotic
Inj methylene blue 75 mg iv stat dye
Inj pcm 1 gr iv stat nasid
Pc anema - p/r stat Bowel motion

11. NORMAL MEDICATION PLAN: 7-4-22 to 13-4-22
DRUG DOSE DAYS FREQUENCY ROA CATEGORY
INJ PANTOP 40 mg 7 UPTO 19TH OD IV PPI
INJ
OPTINEURON
1 amp 7 UPTO 19th OD IV VIT
SUPPLEMENT
INJ MONOCEF 1 gm Upto 11th BID IV CEPHALOSPHORI
NS
VIT C INJ 1.5 gms Upto 16th TID IV VIT
SUPPLEMENT
INJ THIAMINE 100 mg Upto 16th OD IV B1 SUPPLEMENT
INJ VIT K - Upto 9th OD IV COAGLANT

12. INJ EMECET 4mg Upto 9th BID IV ANTIEMETIC
INJ VIT E 400mg Upto 11th BID R/T VIT
SUPPLEMENT
INJ METHYLENE
BLUE
75mg/100ml NS UPTO 9th BID 1 DAY
OD 2 DAYS
IV DYE
TAB METEXL 25mg Only 9th BID PO BETA-BLOCKER
INJ CLEXANE 0.4ml Upto 10th
Dose changed to
1.6 ml
BID SC anticoagulant
FENTANY INJ 500 mcg+40 ml
NS
2 times 7 ml/hr speed IV PAIN KILLER
NORMAL SALINE
+ INJ TACHYRA
600 mg 1 time 5 ml/hr speed IV ANTI
ARRTHYMIC

13. 11-4-22 to 17-4-
22
INJ MAGNEX
FORTE
1.7 gm 2 DAYS DOSE
CHANGED ON
14TH
BID IV ANTIBIOTIC
Syp CREMAFFIN 20ml 7+2 DAYS PO H/S LAUXATIVE
TAB ATIVAN 0.5 mg 6+2DAYS
DOSE CHANGED
ON 13th
OD
BID
PO ANOXIOLYTIC
TAB RANOZEX 500 mg 1 day
8 days
OD
BID
PO SEDATIVE
HYPNOTIC
TAB OMG 3
FATTY ACID
1 TAB 8 days OD PO TREAT HEART
DISEASES
TAB
DABIGATRAN
150 mg 8 days BID PO ANTI-COAGULANT
TAB LIBRIUM 2.5 mg 7 days
1 day
BID
OD
R/T BENZODIAZEPINES
TAB MANEX
FORTE
3 gm 6 days
2 days
BID
OD
IV ANTIBIOTIC

14. FARM NOTES-
1 . Finding - Pantoprazole + dabigatran .
Assessment - If have stomach ulcer , may increase risk of bleeding,
blood clots and abdominal pain .
Monitoring - Monitor internal bleeding .
2 . Finding - Enoxaparin + dabigatran .
Assessment - Increases risk of bleeding , severe haemorrhage .
Monitoring - Monitor for internal bleeding .