2. CASE PRESENTATION 영동 세브란스 병원 응급의학과 R1 김민정

3. 32/F Chief Complaint : 중화제를 먹었어요. Duration : 내원 30 분 전 Past History DM / HTN / Pul.Tbc / Hepatitis (-/-/-/-) No psychiatric history

4. Present Illness 미장원에서 일하는 주부로 수개월 전부 터 미장원 운영에 필요한 자금을 빌려 쓰 기 시작하였으며 빚이 많아져 남편과 자 주 다투었고 이 때부터 의욕도 없고 식사 도 조금씩 밖에 하지 못하였다고 함. 내원 당일 빚 문제로 남편과 다툰 후 남 편이 무섭고 미안하여 미장원에서 쓰는 중화제 3 통을 마시고 응급실 내원함.

5. DI profile-1 Ingestion time 내원 30 분 전 (10/31, 16:20) Prehospital vomiting : (-) Ingestion drug mane and dose 중화제 (Bromate), 50 cc X 3 bottles unknown concentration

6. DI profile-2 GI decontamination L-tube irrigation : not done Activated charcoal : 50g per oral Co-ingestion material : (-) Suicidal Ideation : impulsive

7. Review of System fever/chill/general weakness (-/-/-) headache/dizziness (-/-) nausea/vomiting (-/-) dyspnea/cough/sputum/hemoptysis (-/-/-/-) palpitation/chest pain (-/-) abdominal pain/diarrhea/constipation (+/-/-) hematemesis/hematochezia/melena (-/-/-) hematuria/oliguria/dysuria (-/-/-) flank pain/back pain/others (-/-/-)

8. Physical Examination-1 Vital sign BP 138/99mmHg, PR 98bpm, RR 21rpm, BT 36˚ C General appearance alert mental status acute ill - looking appearance Skin warm and dry, skin lesion (-) HEENT isocoric (4mm/4mm) with PLR (+/+) anicteric sclerae, not pale conjunctivae

9. Physical Examination-2 Neck supple, tenderness (-) Chest regular heart beat without murmur clear breath sound without rale Abdomen soft and flat, normo active bowel sound direct tenderness on epigastric area Back & Extremities CVA tenderness (-/-) No LOM

10. Impression Drug Intoxication, Bromate R/O depressive disorder

11. Plan Routine Lab, EKG, Chest X-ray, ABGA GI decontamination IV hydration Hemodialysis if indicated PSY consultation

12. Chest X-ray

13. Laboratory result CBC WBC 5010/uL(72.5%)Hb 15.4g/dL Hct 42.6%Platelet 295000/uL BUN/Cr10.0/0.8 mg/dL AST/ALT21/11 IU/L Electrolyte Na / K / Cl / tCO 2 138/3.8/99/22 mmol/L ABGA pH 7.611PO 2 154.9 mmHgPCO 2 23.7 mmHg HCO 3 24mmol/LBE +4.6Sat. 99.7% HD#2 Cr 2.5 mg/dL

14. Lasix Progress Cr 2.5  3.5  1.7  2.6  2.2 (mg/dL) HD