Multiple Tablet Ingestion

CASE STUDY ON MULTIPLE TABLET
INGESTION
SUBMITTED TO: PRESENTED BY:

Dr.B.SWATHI RAKESH VANAM
ASST.PROFESSOR 17CE1T0017
INTRODUCTION
• Poisoning is commonly due to ingestion but can result from injection, inhalation, or exposure of
body surfaces (eg, skin, eye, mucous membranes). Accidental poisoning is common among young
children
• , Poisoning is also common among older children, adolescents, and adults attempting suicide;
multiple drugs, including alcohol, acetaminophen, and other OTC drugs, may be involved. After
exposure or ingestion and absorption, most poisons are metabolized, pass through the GI tract, or
are excreted.
• SYMPTOMS OF MULTIPLE TABLET INGESTION
• Ingested and absorbed toxins generally cause systemic symptoms. Caustics and corrosive liquids
damage mainly the mucous membranes of the GI tract, causing stomatitis, enteritis, or perforation
• DIAGNOSIS: History , CBP, urine testing, CT scan.
• Signs and symptoms of poisoning may include:
• Burns or redness around the mouth and lips.
• Breath that smells like chemicals, such as gasoline or paint thinner.
• Vomiting.
• Difficulty breathing.
• Drowsiness.
• Confusion or other altered mental status.
SOAP ANALYSIS
• Subjective evidence:
• PATIENT DEMOGRAPHIC DETAILS
• Name: Shaikh Ahmed
• Age:33yrs male
• Ipno: 1190. Doa:29/7/22
• Unit chief: Dr. Venkat krishna
• CHIEF COMPLAINTS: patient was brought with alleged symptoms
• H/o consumption of 15tab at his residence at 4pm
• Tablets: sleeping pills , avil, naphthalene balls
• H/o of present illness: c/o giddiness and shivering then 2episodes
of vomiting after that no h/o other complaints
• Pain in abdomen
• PERSONAL HISTORY: sleep-normal
• Bowel –regular
• OBJECTIVE EVIDENCE
• General examination
• Cvs: s1s2+
• RS : BAE+, clear
• P/A: soft
• Vitals: patient afebrile , tongue moist
Vitals Day1 Day2
Pulse rate 90bpm 80bpm
Blood pressure 120/70mmHg 100/70mmHg
Spo2 96%
GRBS 117mg/dl
Investigations Normal range Reports

Serum creatinine 0.6-1.4mg/dl 1
Laboratory
Serum sodium investigations
135-155meq/l 140
Blood urea 15-45mg/dl 20
Serum potassium 3.5-5.5meq/l 4.5
Serum chloride 97-110meq/l 107
Day 2
Patient case of disturbed and decreased sleep
speech scanting
urine examination
quantity-50ml
appearance-turbid
Colour-straw
reaction –acidic
albumin-+
psychotic episodes ( acute)

Investigations Normal range Test report
Hb ,% 13-17% 14.7%
WBC 4000-1000/cumm 8000
RBC 4.5-5.5mill/cumm 4.9
Neutrophils 40-80% 74%
Lymphocytes 20-40% 20%
Eosinophils 1-6% 3%
Monocytes 2-10% 3%
PCV 40-50% 44%
MCV 83-101F1 90
MCH 27-32pgm 30
MCHC 31.5-34.5 33%
Platelets 1.5-4lahks/cumn 8lakhs
ESR 0-30mm 10
• Assessment:
• Based on subjective and objective evidences the case is diagnosed as
multiple tablet ingestion.
PLANNING:
Treatment
Goals of treatment: to reduce the symptoms And enhance
elimination
Brand name Generic Category Dose Route of Frequency
name administrati
To administer specific antidotes to prevent reexposure
on
Inj pan Pantoprazol H+ pump 40mg IV Od
e inhibitor
Inj zofer Ondonsetro Antiemetic 4mg IV SOS
n
T flatuna Semithecon Anti 4tbs P/o Stat
e flatunated
Clonotril Clonazepam Benzodiaze 0.5mg Oral Od

pine
Ativan Lorazepam Benzodiaze 2mg Oral Od
pine
Oxetol Oxacarbazin Anticonvuls Itab Oral Od
e ant
Monitoring parameters
• Inj pan: monitor Mg at baseline
• Inj zofer:monitor for serotonin syndrome and reduced bowel activity
• T ccionotril LFT , CBP
• T oxetol:Suicidality ,CBP
• Tflatuna:bowel sounds for peristalsis
• T ativan: monitor for IV site administration
• Toxicity parameters:
• Inj pan : stomach pain, headache, constipation
• Inj zofer: sensation of warmth, flushing, headache
• T. Clonotril: drowsiness, dizziness, increased saliva
• T. Oxetol: vomiting, weakness, headache
• T. Flatuna: dark stools, constipation , vomiting
• T. Ativan : drowsiness, dizziness, lack of coordination
• MECHANISM OF ACTION AND CATEGORY
• Pantoprazole:
• The mechanism of action of pantoprazole is to inhibit the final step in gastric acid production. … Pantoprazole binds irreversibly to H+K+ATPase (proton pumps) to suppress
the secretion of acid. Due to irreversible binding of the pumps, new pumps have to be made before acid production can be resumed.
• Category: proton pump inhibitor
• Zofer:
• Zofer Injection works by inhibiting the action of a chemical substance known as serotonin. Serotonin is responsible for inducing nausea and vomiting. Ondansetron binds to
a receptor known as 5-HT₃, thus inhibits the binding of serotonin to it and prevents vomiting and nausea
• Category : serotonin receptor antagonist
• Clonotril:
• Clonazepam is a potent anticonvulsant 1,4-benzodiazepine that controls some types of myoclonus. Its primary mode of action is to facilitate GABAergic transmission in the
brain by a direct effect on benzodiazepine receptors.
• Category: benzodiazepine
• Oxetol:
• The precise mechanism by which oxcarbazepine and MHD exert their ant seizure effect is unknown; however, in vitro electrophysiological studies indicate that they produce
blockade of voltage-sensitive sodium channels, resulting in stabilization of hyper excited neural membranes, inhibition of repetitive neuronal firing
• Category:
• carbamazepine :
• Can carbamazepine be used for psychosis?
• Carbamazepine is an anticonvulsant and mood ‐stabiliser with a tricyclic structure. It has been employed in treatment of a variety of psychiatric
disorders, including schizophrenia, where it has been used as an antipsychotic agent.
• T. Flatuna:
• Combination of two drugs: Simethicone (anti-flatulent). Simethicone works by decreasing the surface tension of gas bubbles, thereby facilitates the expulsion of gas throug
flatus or belching (burping). It also prevents the accumulation and formation of gas in the digestive tract.
• Category: anti flatulence
• Ativan:
• Lorazepam binds to benzodiazepine receptors on the postsynaptic GABA-A ligand-gated chloride channel neuron at several sites within the central nervous system (CNS). It
enhances the inhibitory effects of GABA, which increases the conductance of chloride ions into the cell.
• Category: benzodiazepine.
• PROBLEMS IDENTIFIED:
• Drug – drug interactions
• • Lorazepam + clonazepam : Using Lorazepam together with OXcarbazepine
may increase side effects such as dizziness, drowsiness, confusion, and difficulty
concentrating.
• • clonazepam + OXcarbazepine
• OXcarbazepine may reduce the blood levels and effects of clonazepam. Contact
your doctor if your symptoms worsen or your condition changes during
treatment with these medications.
• • Ondansetron+ Oxcarbazepine:
• • MONITOR: Coadministration with oxcarbazepine may decrease the
plasma concentrations of drugs that are substrates of the CYP450 3A4 isozyme.
• Drug – food interactions:
• • Lorazepam+ food
• • GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic
effects of CNS-active agents. Use in combination may result in additive central
nervous system depression and/or impairment of judgment, thinking, and
psychomotor skills.
• PATIENT COUNSELLING
• Disease related:
Poisoning can occur from a variety of factors like medications . Poisoning is a medical emergency and cannot be treated at
home. Hence seek medical care immediately
Drug related
• inj pan: take 30 mi Before a meal
• Inj zofer: may be taken with or without food
• Toxetol: take on empty stomach atleast an hour before meal
• T.ativan: avoiding drinking alcohol
• T.cionotril:donor take this medication longer than 9 weeks
• Lifestyle modifications
• Enhance diet
• Make exercise a priority
• Practice techniques to reduce stress
• Get enough sleep

Multiple Tablet Ingestion

Uploaded by

Copyright:

Available Formats

Multiple Tablet Ingestion

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Multiple Tablet Ingestion

Uploaded by

Copyright:

Available Formats

CASE STUDY ON MULTIPLE TABLET

SUBMITTED TO: PRESENTED BY:

Investigations Normal range Reports

psychotic episodes ( acute)

Clonotril Clonazepam Benzodiaze 0.5mg Oral Od

You might also like