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TOXICOLOGY CONFERENCE
Presented by F1 林立原Instructed by Dr.許景瑋2011/11/11
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General Data
Age: 45-year-old Gender: male Ethnic: Taiwanese Marital status: single Occupation: worker
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Chief Complaint
Burning clothes in room with drowsy conscious
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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.
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Past History
No hypertension or diabetes mellitus No operation history of major organs
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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
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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
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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
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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
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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
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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
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CXR
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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
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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
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Discussion
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The end