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Joanna Loren J. Ochia


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àhis is a case of S.Y., one year and eleven
months old, male, Filipino, Roman Catholic,
currently residing in Canlalay, Laguna,
admitted for the first time at around 8 o¶clock
in the evening of May 24, 2008 at UPH-
DJGàMC.
˜ !  ! 
ÿomiting

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Mother 90
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One hour prior to admission, patient ingested


approximately 10ml of pesticide, which his mother
mistakenly thought of as a bottled iced tea. Few
minutes after, patient manifested whitish bubbles
around the buccal area, hyperventilation, and
vomiting for several times with vomitus amounting to
about one to two cups per episode. Patient was then
rushed to UPH-DJGàMC for further evaluation and
management.
˜ u   
Patient was born from a 22 y.o. G1P1
mother, who had regular prenatal check-up
and intake of essential vitamins. àhere was
no mentioned exposure to radiation but had
Uà during the 5th of pregnancy with
unrecalled medication.
˜ · 
Patient was born via NSÿD assisted by a
midwife with noted spontaneous breathing,
good cry, no cord coiling and meconium
stain.
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Urine and meconium were excreted
within 24 hours.
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Patient was formula-fed since birth with
Bona 1:1 dilution and was weaned at 6
months of age.
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Patient can pull to stand at 10 months of
age and able to work alone at 13 months and
can currently speak 2 words at a time.
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*  BCG
*  HEPA B *3doses
*  DPà *3doses
*  Measles
*  OPÿ *3 doses
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*- Hospitalization
*- Asthma
*  Colds
*  Cough
˜ Ô 
*- Asthma
*- DM
*- HPN
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Patient lives in a non-congested area
together with parents, water for drinking is
purified, and electricity is always available.
No stagnant water can be found in the area
and the garbage collection is done every
week.
 
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Drowsy, cardiorespiratory distress.


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CR: 90
RR: 22
BP: 120/40
àemp: 36.7%
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No lesions, warm to touch, good skin turgor.

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Sunken eyeball, pale palpebral conjuctiva,
anicteric clear, no nasal discharge, no
tonsillopharyngeal congestion, no cervical
lymphadenopathy, wet mucosa.
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Symmetrical chest expansion, *  rales
both lung fields, *  retractions.

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Adynamic precordium, tachycardic
rhythm, no murmurs.
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Flat, hypoactive bowel sounds, soft, no
tenderness, no organomegaly.
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Not assessed.
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No gross deformities, good pulse.

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ORGANOPHOSPHAàE PO SON NG
˜ ·  
- miosis
- salivation
- sweating
- bronchial constriction
- vomiting
- diarrhea
- neuropathy associated with demyelination of
axons.



˜ Organophosphates
± Cholinesterase inhibitors
± ndirect cholinomimetic action
± àarget acetylcholinesterase
± ncrease acetylcholine by inhibiting AChE
± Mechanism is through phosphorylation of the
serine hydroxyl group located at the active site of
AChE.
˜ Organophosphates can be absorbed
cutaneously, ingested, inhaled, or injected.

˜ Although most patients rapidly become


symptomatic, the onset and severity of
symptoms depend on the specific compound,
amount, route of exposure, and rate of
metabolic degradation.
˜ u 
      

± Controlling the signs of muscarinic excess by
administering an antimuscarinic therapy.
± Maintenance of vital signs²respiration in
particular may be impaired
± Decontamination to prevent further absorption
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Drugs Effectivity Safety Suitability Affordability

Atropine
Sulfate
(Anespin) +++ - + ++++

Pralidoxime + - ++ ++
˜  ·    u  

Atropine Sulfate ÿ
 
JOANNA LOREN J. OCH A, M.D., FPCP, FPCC
Cardiology- nternal Medicine
Cell no.: *0917360-6954

Name of Patient: Maverick Rodriguez Date: June 5, 2010


Address: Biñan, Laguna

Rx
Atropine Sulfate Ampule 1mg/mL
*Anespin 1

Sig: Administer 0.3mL ÿ every 15 minutes until atropinization is reached.

Refill: none

JOANNA LOREN J. OCH A, M.D.


Lic. No.: 0054321
PàR No.: 3984529

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Effects of the Drug

Atropine is given as often as required to control


signs of muscarinic excess.

t is an anticholinergic agent which competitively


blocks the muscarinic receptors in peripheral
tissues such as the heart, intestines, bronchial
muscles, iris and secretory glands.
àoxic doses cause tachycardia, hyperpyrexia,
restlessness, confusion, excitement,
hallucinations, delirium and may progress to
circulatory failure and respiratory depression.
Some central stimulation may occur. Atropine
abolishes bradycardia and reduces heart block due
to vagal activity. Smooth muscles in the bronchi and
gut are relaxed while glandular secretions are
reduced. Atropine is an effective competitiveinhibitor
at muscarinic sites but has no effect at nicotinic sites.
Side Effects

Possible side effects are dry mouth, dysphagia,


constipation, flushing and dryness of skin,
tachycardia, palpitations,arrhythmias, mydriasis,
photophobia, cycloplegia, raised intraocular
pressure.
nstructions

Atropine Sulfate SD 1mg/ml; RD 0.05 mg/kg body


wt.; administer 0.3mL ÿ every 15 minutes
until the four parameters of atropinization is
reached like HR >140/min, hypoactive bowel
sounds, pupil >4mm and dry mouth.
>arnings

Overdosage of atropine may cause hyperthermia,


hypertension, increased respiratory rate, nausea
and vomiting. t may also lead to CNS stimulation.
Severe intoxication on the other hand may lead to
CNS depression, coma, respiratory failure and
death.
H4NKSZ FPHOU!