Chandrashekhar K.1, Seetaram N.K.2, Gayatri B.H.3, Ishwar S. Hasabi4, Suryakanth N. Betageri5
A 40-year-old male patient was admitted to the emergency ward with alleged
history of consumption of 2 fresh tablets of aluminium phosphide (56 %) of 3
gram each an hour back, following ingestion of which patient developed nausea
and vomiting 10 - 12 times. Vitals at admission and subsequent days has been
charted in Table 1.
After placement of nasogastric tube, gastric lavage was done and initiated
inotropes in view of hypotension then patient was shifted to medical intensive care
unit (ICU) with guarded prognosis. Routine blood parameters including cardiac
biomarkers imaging, echocardiography, electrocardiography were normal. The day
after the admission, patient was awake, alert and blood pressure (BP) was normal
with inotropic support.
On the 3rd day patient’s condition deteriorated. Patient needed O2 support in
the form of non-rebreather mask (NRBM) 15 litres to maintain saturation and
needed escalation of inotropes for blood pressure maintenance. Patient developed
bradycardia. Cardiac biomarker, echo, electrocardiogram (ECG) revealed toxin
induced myocarditis and X-ray suggestive of early ARDS. Tab isoprenaline 10 mg
BD was stared after cardiology consultation. With supportive measures and
treatment as shown in the table 3, patients clinical condition improved and was
taken off from inotropes and O2 supplementation. The patient responded to
supportive measures over the next 4 days. On day 7, blood parameters, imaging
studies, echo, ECG were repeated and were in decreasing trend.
On day 11 patient was discharged after clinical stabilization and psychiatry
counselling.
