TOXICOLOGY CONFERENCE

Presented by F1 林立原Instructed by Dr.許景瑋2011/11/11

General Data

Age: 45-year-old Gender: male Ethnic: Taiwanese Marital status: single Occupation: worker

Chief Complaint

Burning clothes in room with drowsy conscious

Present Illness

This 44-year-old male has unremarkable medical history except aloholism and alcoholic liver disease. He was sent to the ED because of burning clothes in room with drowsy conscious, which was noticed by his elder brother.

At ED, brain CT showed no intracranial hemorrhage. CO-Hb level was 23%, along with profound shock, leukocytosis and bandemia.

Past History

No hypertension or diabetes mellitus No operation history of major organs

Personal History

No known allergy to food or drugs Smoking: denied by his brother Alcohol consumption: heavy drinker Betel nuts chewing: denied by his

brother

Physical Examination T 36℃ P: 125/min, R: 24/min, BP: mmHg Height: 160cm, weight: 50kg, BMI:19.5 Consciousness: E4V4M6 HEENT: pink conjunctiva, no thyroid goiter Chest: rapid and labored respiration,

bilateral clear breathing sounds. Heart: regular heart beats, no murmurs. Abdomen: soft, flat, normal bowel sounds Extremity: freely movable, no pitting

edema. Skin: ecchymoses over lips, knees and

legs

Laboratory Findings

Hemogram

unit 10/07

WBC /uL 23200

RBC million/uL

2.55

Hemoglobin

g/dL 9.5

Hematocrit % 26.3

MCV fL 103.1

MCH pg/cell 37.3

MCHC g/dL 36.1

RDW % 12.7

Platelets /uL 76k

Segment % 55.0

Lymphocyte

% 7.0

Monocyte % 7.0

Band % 28.5

10/07

PT sec 18.9

INR 1.8

aPTT sec 42.0

D-dimer Ng/ml 4552

Laboratory Findings

Biochemistry Unit 10/07

BUN mg/dL 37.2

Cr mg/dL 2.87

Na Meq/L 135

K Meq/L 2.7

AST U/L 167

CRP mg/L 176

Troponin I ng/mL 0.170

Ammonia Ug/dL 65

Myoglobin Ng/mL 338

Laboratory Findings

Biochemistry

Unit 10/07 10/07

T- HB g/dL 10 10.5

O2 HB % 73.6 98.1

CO HB % 23.0 0.5

MET HB % 1.1 0.1

O2 SAT % 97.0 98.7

Alcohol <5

Benzod 475

Amphetamin

absent

Unit 10/07

pH 7.32

CO2 mmHg

26.4

O2 mmHg

303

HCO3 Mm/L 13.4

Sat % 99.7

Laboratory FindingsUrinalysis 10/07

Color Dark Yellow

Turbidity Cloudy

Sp. Gravity 1.015

pH 5.5

Leukocyte 2+

Nitrite Negative

Protein 1+(30)

Glucose Negative

Ketone Negative

Urobilinogen 2.0

Bilirubin Negative

Blood 2+

RBC 20

WBC 106

Epi. 8

CXR

Hospitalization course

Cr: 2.87(10/7)

Cr: 0.46(10/9)

10/21Fasciotomy

Ceftriaxone10/07~10/12

Ceftazidime 10/12~11/03

Musculoskeletal CT

MBD11/04

Impressions

Carbon monoxide intoxication Septic shock, focus: left hand

cellulitis and urinary tract infection; urine and wound culture: Pseudo. aeruginosa

Acute kidney injury, RIFLE-F, due to rhabdomyolysis

Macrocytic anemia, favor alcoholism related

Acute hepatitis, consider shock liver

Discussion

The end