patient history review

PATIENT HISTORY

REVIEW

A CASE STUDY

© PANKHIL GANDHI

PATIENT HISTORY REVIEW

RT, a 34 year old male, is a patient at GHATI (Aurangabad) who is beingtreated for organophosphate poisoning. He was brought to the hospital withchief complaints of vomiting, dizziness and abdominal cramps. Upon arrivinghis body was washed and he was given gastric lavage. He was given inj. Emeset& atropine I.V. 40 mg continuous infusion. He was also given PAM(pralidoxime) in 0.9% NS.

Following is a conversation between Mr. RT and a Pharm D. student.

name of the patient has been changed for maintaining confidentiality.© PANKHIL GANDHI

THE PRESCRIPTION

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OBTAINING PATIENT

HISTORY

THE CONVERSATION

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Hello, I am XY, a Pharm D. student and you must be Mr.

RT ?

Would you be comfortable to answer a few questions ?

How are you feeling now Mr. RT?

Yes, absolutely.

I am feeling quite well sir.

Hello sir. Yes my name is RT.

© PANKHIL GANDHI

Could you please give me the name and contact number

of that doctor so that I can talk to him and confirm your

initial treatment ?

I don’t have it with me at the moment, but I will surely

give it to you tomorrow.

(XY questions RT’s brother)

Can you recall the treatment he was given at the clinic ?

The doctor gave him some tablets. I don’t know which.

But his condition did not improve. In fact he started

vomiting severely. So I had to bring RT here.

Your files say that you have been brought here because of

pesticide poisoning. Is that correct ?

Yes, it is correct. I was in my farm, spraying pesticides on

the crops. While returning home I felt dizziness and I

started vomiting. My brother took me to a clinic near by.

© PANKHIL GANDHI

Thank you. Now, RT can you tell me something about

your treatment at this hospital?

When I was brought here, they washed my body. They then

inserted a tube through my nose and from it passed a purple

solution into my stomach. They also removed contents from

my stomach.

What happened next?

I am glad to know that you are feeling better now. Let me

brief you with your treatment.

Then they gave me saline. And now I am feeling good.

Sure. Please go ahead.© PANKHIL GANDHI

You were then given atropine mixed in the saline solution.

Atropine is an antidote for pesticides. You are also being

given PAM. This too us an antidote.

Ok

I think when you came here, you first given an injection.

It was to stop your vomiting.

Yes, that’s right. I forgot to tell you about it.

The purple solution given to you was potassium

permanganate. It was given to clean your stomach of all

the toxins.

Ok.

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Well, your condition seems quite stable now. I think you

would be ready to be discharged by tomorrow. Still let me

confirm with your physician.

Ok. Thank you, sir.

That is because you have a dry mouth. It is a side effect

of atropine. Don’t worry, it will go away once we stop

atropine and you are discharged.

When would I get discharged?

Do you have anything else that you wish to tell me?

Yes. I feel very dry and want to drink water even though

I am not thirsty.

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I hope I have answered your questions and made you

understand your treatment well, haven’t I ?

Yes sir, thank you very much.

Have a good day Mr. RT. Get well soon

Thank you.

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COUNSELLING THE PATIENT

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POINTS FOR COUNSELLING

• ATROPINE – this is given as an antidote to pesticide poisoning. It will cause

dry mouth and dilated pupils which may cause blurred vision. Do not worry,

they will go away once we stop your treatment.

• PAM (pralidoxime) – this is also an antidote.

• Inj. Emeset – this is a brand name for ondansetron. Ondansetron is given to

you to prevent your vomiting. You might feel mild headache. If it is severe,

kindly report your physician. There are minor chances that you may still feel

nauseous. Report your physician if it happens.

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• You were given gastric lavage with potassium permanganate to remove any

poison present in your stomach

• Your body was washed to remove any pesticide present on your skin.

Pesticides can be absorbed into the body from skin. To prevent this, it is

necessary to wash body thoroughly. I advise you to discard your clothes that

you were wearing while spraying pesticides. Also, from next time remember

to cover your face and body properly before spraying pesticides.

© PANKHIL GANDHI


• Pesticides can be stored in body fat and can release slowly for a few days.

This might lead to poisoning again. After proper treatment, there are very

rare chances of such incidence to happen, but still if you feel any dizziness,

drowsiness, nausea, vomiting, headache, tremors or blurred vision then

immediately come to hospital along with your case papers.

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ATROPINE

• MOA - Atropine antagonizes Ach by competing with it and other muscarinic agonists for a common binding site on the muscarinic receptor.

• OTHER INDICATIONS - Possibly effective for treatment of irritable bowel syndrome and acute enterocolitis. Also may be useful as adjunctive therapy for duodenal ulcer.

• ADRs - Blurred vision; mydriasis; photophobia; cycloplegia; increased IOP; atropine fever and atropine flush; inhibition of secretions

• INTERACTIONS - Anticholinergic agents: Additive anticholingeric effects. Haloperidol:Worsened schizophrenic symptoms; decreased haloperidol concentrations. Phenothiazines:Decreased antipsychotic effects and increased anticholinergic effects may occur.

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PRALIDOXIME

• MOA – PAM is a choline-esterase rescuer. It binds to choline-esterase

inhibitors and frees the enzyme choline-esterase

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ONDANSETRON

• MOA - Selective serotonin (5-HT3) receptor antagonist that inhibits serotonin

receptors in chemoreceptor trigger zone.

• OTHER INDICATIONS – for pre-operative and post-operative nausea/vomiting;

emetogenic chemotherapy; general nausea and vomiting; motion sickness

• INTERACTIONS - Rifamycins (eg, rifampin): Plasma levels of ondansetron may be

reduced, decreasing the antiemetic effect. Parkinsonism: contraindicated to be used

with apomorphine.

• ADRs – tachycardia; headache; seizures; rash.

© PANKHIL GANDHI

patient history review

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