30/F RAT POISONING

30 yr female came to casuality with c/o consumption of rat poison (1 full tube approx 15g) 2 weeks ago, f/b vomitings 3 episodes next day with food as contents(subsided next day) and yellowish discoloration of eyes.
Day 6- developed SOB and pedal edema
Day 7-was admitted and treated in outside hospital,later she developed constipation and reduced urine output since past 2 days, anuria since afternoon
N/k/c/o DM,HTN,CAD,Asthma

O/E:
Pt c/c/c

Temp- 98.6 f
BP- 120/80 mmhg
PR- 78 bpm
Rr- 18 cpm
Spo2- 97% at 8lit o2
Cvs- S1 S2 +,no murmurs
Cns- no fnd
Rs- Bae+, reduced breath sounds in b/l iaa,isa
P/A- Distended,Petechial rashes +, tense

Diagnosis: ? yellow phosphorus poisoning with acute liver failure, Acute lung injury

Cue- Alb+, sugars nil

Rx given:

Ivf NS,RL,DNS @UO+30ml/hr
Inj.OPTINEURON 1 amp in 100ml NS IV OD
Inj.Vit K 10mg IV OD slow iv
Inj.PAN 40mg iv od
Inj.UDILIV 300mg PO BD
Inj.ZOFER 4mg IV BD
Syp.LACTULOSE 20ml PO H/S
Inj.NAC 6000mg in 500 NS over 4hrs f/b 2000mg in 500ml NS over 8hrs f/b 400mg in 500ml NS over 16hrs
Inj.MONOCEF 1gm IV bd
Syp.LIV 52 10ml po bd

Ivf dns with 8U HAI IV stat over 3 hrs.

31/12/21:

S - fever spikes-

O- Pt under sedation

Inj dexmedetomidine infusion(20mcg/hr) @ 5ml/hr

Temp- 99f

Bp-110/70mmhg

PR-120bpm

RR- 28cpm

Spo2- 97% with 10lit o2

Rs- bae+, b/l inspiratory crepts + at mammary area , infraaxillary area

Cvs- s1 s2+

P/a- distended, bs sluggish 

Cns- Gcs E1V1M4

A - ?yellow phosphorus intoxication 

Fulminant hepatic failure sec to toxin

B/l moderate pleural effusion 

P-

Ivf NS ,RL , DNS @ 50ml/hr

Inj monocef 1gm iv bd

Inj pantop 40mg iv Od

Inj zofer 4mg iv bd

Inj optineuron 1amp in 100ml NS iv od

Bp/ PR / spo2 charting 4thrly

Strict I/0 charting 

Grbs charting 6th hrly

1/1/22 :

S - fever spikes-

O- tapering the sedation

Inj dexmedetomidine infusion(20mcg/hr) @ 2ml/hr/hr

Temp- 99f

Bp-100/60mmhg on inj noradrenaline @8ml/hr

PR-120bpm

RR- 28cpm

Spo2- 97% with 10lit o2

Rs- bae+, b/l inspiratory crepts + at mammary area , infraaxillary area

Cvs- s1 s2+

P/a- distended, bs sluggish 

Cns- Gcs E1V1M4

A - ?yellow phosphorus intoxication 

Fulminant hepatic failure sec to toxin

B/l moderate pleural effusion 

P-

Ivf NS ,RL , DNS @ 50ml/hr

Inj monocef 1gm iv bd d3 

Inj pantop 40mg iv Od

Inj zofer 4mg iv bd

Inj optineuron 1amp in 100ml NS iv od

Bp/ PR / spo2 charting 4thrly

Strict I/0 charting 

Grbs charting 6th hrly

Afternoon as bp is not Maintaining in single ionotrope we have shifted to double ionotrope still bp hasn't improved and around 8pm central pulses are absent and cpr has been initiated and couldnt be revived 

Cause of death : Refractory hypotension secondary to sepsis and multiorgan dysfunction syndrome