Sarvodaya Hospital, Paratwada

POISONING WITH HYPOXIA

Date: 03/03/2022

45yr male was admitted with history of consumption of insecticide accidental while spraying in the farm one week back. Patient was then admitted to SDH and Amravati GH where lavage was done and symptomatic treatment given- those details were not available. Patient was found to have hypoxia at SDH almost five days before for which patient was referred to higher centre- patient went to home and then came back to Sarvodaya Hospital.

Patient had pain abdomen and hypoxia (post poisoning history) on admission. It was happy hypoxia and was not responding to oxygen. This hypoxia was evaluated but no definite cause could be established. Hypoxia was observed for one day but when the hypoxia was worsening, steroids and vitamin c were added. The hypoxia finally responded steroids. Reason for hypoxia likely to be methhemoglobinemia as suggested by refractory to oxygen supplementation and mild hemolysis with high indirect bilirubin. But the Pa02 on ABG was less which goes against the diagnosis of methhemoglobinemia. Patient had post prandial pain abdomen which could be due to gastritis or ascending colitis which responded to antibiotic tazomac and PPI. Patient recovered gradually with supportive treatment and was absolutely stable on discharge.

Consultant: Dr Devendra Agrawal (M.B.B.S., D.N.B. Medicine)

DATE	Hb	TLC	Platelet	Creat	RBS	CRP TEST	Urine TEST	BILIRUBIN	SGOT / SGPT
23/02/2022	12.3	19000	1.11	1.01	67	9.13	PUS CELL-OCCASIONAL	Total – 4.49 Direct – 1.15 Ind – 3.34	33 28
24/02/2022	11.3	23400	0.86	-	-	10.72	-	Total – 4.79 Direct – 1.97 Ind – 2.82
24/02/2022	D DIMER TEST – 1660, amaylase - 68
25/02/2022	10.4	24300	0.80	-	-	8.02	-	Total – 8.83 Direct – 2.50 Ind – 3.33
25/02/2022	9.3	22200	0.74	-	-	-	-	-
26/02/2022	9.6	22300	0.89	-	-	-	-	TOTAL-6.90 DIRECT-2.95 INDIRECT-3.95
27/02/2022	8.6	16900	1.08	-	-	-	-	TOTAL-10.98 DIRECT-6.10 INDIRECT-4.88
28/02/2022	8.6	14500	1.27					TOTAL-12.62 DIRECT-08.17 INDIRECT-4.45	107 288
01/03/2022	8.8	14300	1.71	-	-	-	-	TOTAL-15.65 DIRECT-11.61 INDIRECT-4.04
02/03/2022	9.6	16600	2.64	-	-	-	-	TOTAL-7.25 DIRECT-1.92 INDIRECT-5.33

DATE	Imaging
25/02/2022	PH – 7.438 PCO2- 38.5mmhg PAO2 – 36.7mmhg BE – 1.3 TCO2 – 26.6
23/02/2022	SONOGRAPHY A/P- Minimal ascites is seen. small left renal non obstructive calculus.
23/02/2022	XRAY CHEST PA- No significant abnormality is seen in the chest.
23/02/2022	ECHOCARDIOGRAPHY-Normal chamber dimensions, no regional wall motion abnormality at rest, good left ventricular systolic function, LIVE 60%, no diastolic dysfunction. Valves are normal or no valvular abnormality, no regurgitation or stenosis, no abnormal shunting is seen, no pulmonary hypertension, no clot/vegetation/pericardial effusion.
24/02/2022	PULMONARY ANGIOGRAPHY- No e/o pulmonary embolism. Few fibrotic foci involving posterior sgment of right upper lobe causing minimal tractional bronchiectasis.
25/02/2022	ECG- Voltage criteria for left ventricular hypertrophy nonspecific t wave abnormality abnormal ECG.
23/02/2022	USG ABDOMEN & PELVIS :- minimal ascites is seen. Small left renal non obstructive calculus.
25/02/2022	CTCT ABDOMEN :- * mild circumferential bowel wall thickening involving the cecum and proximal part of ascending colon with adjacent mild fat stranding and secondarily inflamed appendix – likely infective etiology. * mild hepatomegaly. * bilateral tiny non obstructing renal calculi.