10/03/2021
story of AP poisoning Treated with High Dose Insulin
22 yr young male presented to Unity Emergency with History of Aluminium phosphorus ( A.P.) poisoning..
on presentation Pts looks dyspnoeic & restless
on examination - Hypotension, cold calmy limbs
on investigation ABG - Acidosis
NaHco3 15 & lactate 7.1
Ecg - sinus tachycardia (upto 150)
2D echo - 20 to 25 % EF (myocarditis)
Our team started resuscitation with fluid, Soda bicarb and Noradrenaline infusion..
We had started SLED (Type of Dialysis) to overcome acidosis...
On First Day...
-patient successfully toleratrd 8 hours SLED.. though He had multiple episodic arrhythmias...
on 2nd Day...
ABG Shows Acidosis NaHco3 20/ lactate 4.9
Ecg-Latera wall Ischaemic changes with VPCs & Episodic Arrhythmias
2d echo shows EF-10% (worsening myocarditis)
Noradrenalin requirements increased
Urine output dropped
overall patient looks worsened
we had given option about ECMO but affordability is issue
Dr. Jaydeep Hirapara (Nephrologist) had advised to start high dose insulin.
potassium (K+) Replacement along with MgSo4 & calcium gluconate...
Again SLED started and tolerated for 6 hours.. continue with Insulin infusion and k+ supplement
3rd Day
patient stabilized
No acidosis
developed congestion,
altered liver function
we started to keep at negative balance
4th Day
vitals better, NA Requirements lower down
Urine Output adequate
started Oral Liquid /Removed RT
patient first time Said "अभी मुझे लगता है मे बच जाउंगा"
5th Day Noradrenaline tappered off
6th Day patient Mobilized & shifted to ward
8th Day Discharged with smiling Face
Unity Hospital Team
Dr shailesh Bhayani (Physician)
Dr Jaydeep Hirapara (Nephrologist)
Dr Mahesh Sutariya & Intensivist team
Dr Avinash/Dr Bhavesh (Cardiologist)
Unity Hospital Staff/RMO
We Treat, He (*GOD*) cures