mr-organophosphate poisoning

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