A 21-year-old woman is brought to the Emergency Department. On arrival, she has a tonic clonic seizure that lasts several minutes, which the paramedics say is her second. Relatives say that she drank a bottle of pesticide after an argument with her girlfriend; they had found her conscious but confused and called an ambulance an estimated 30-90 minutes after the ingestion. No bottle was apparent but the patient had mentioned pesticide in her ramblings and she had the smell of kerosene on her breath. After resuscitation and intubation, the paramedics had noted small pupils and sweating and, with the presence of the history and pesticide smell, made the diagnosis of OP poisoning, and gave 2 mg of atropine as well as 10 mg of diazepam. Her pulse is now 130/min, BP 160/100, RR 26/min, saturations 100% on 15 L of oxygen and she has an ET tube in place.
A 21-year-old woman is brought to the Emergency Department. On arrival, she is fully conscious and angrily tells you that she has drunk 200-300ml of pesticide three hours before, after an argument with her girlfriend. She is alert, well and orientated but smells strongly of pesticide. She has pulse 95/min, BP 130/75, RR 32, and oxygen saturation 97% on air. She has past medical history and takes no medications. Examination is unremarkable.
A 21-year-old woman telephones in distress asking for advice. She has just found her 2-year-old son sitting next to the remnants of a mosquito coil with some of it in his mouth. Her child was fine when she discovered him but is crying hard now. She can’t remember the name of the coil exactly but thinks it was something like Lamby-ring. He was alone for 30 minutes; she can’t say how much he has eaten because it had been partly used the night before. She wants to know whether she should give the ipecac she has in her house.