Case presentation oof toxicology, Summaries of Medical Sciences

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Weekly Grand Round Presentation Department of Medicine Dhaka Medical College Hospital

Metabolic catastrophes in acute poisoning: Three life-threatening cases Dr. Md. Shafiul Kabir FCPS Part-2 Trainee (SST) Medicine Unit- Dhaka Medical College & Hospital

Mr. X, 27-years-old, autorickshaw driver, hailing from Kamrangirchor, got admitted to DMCH on 12 th January, 2026 with the complains of - PRESENTATION Altered level of consciousness for 10 hours History of alcohol ingestion 36 hours back

Initially developed altered state of consciousness followed by complete loss of consciousness. He was then brought to DMCH for further management History of around 750 ml of alcohol ingestion 36 hours back. No history of exposure to any other toxin or any illicit drug abuse, GI disturbance, visual blurring, epigastric pain or chest pain

INVESTIGATIONS

Immediately after admission: ABG High anion gap metabolic acidosis Fluid trial was started & ABG was repeated after fluid trial: Acidosis had resolved after fluid trial

PARAMETE

RS

VALUE

pH 7. pCO 2

mmHg HCO 3

mmol/L Base Excess

mmol/L Anion Gap 30

PARAMETE

RS

VALUE

pH 7. pCO 2 32 mmHg HCO 3

mmol/L Base Excess

mmol/L Anion Gap 30

Differential diagnoses Next step

The patient was oriented and had no significant symptoms by the end of fluid trial We did bedside urine strip test which showed: Glucose: - Ketone: 1+

DIAGNOSIS Alcoholic Ketoacidosis

TREATMENT  NPO till further order  (^) Fluid trial: (Within 60 mins)  Inf. Ringers lactate (1L)  Inf. 5% DA (1L)  Inj. Thiamine (25 mg)  Urinary catheterization to monitor urine output

Mr. X, 16-years-old, Student, hailing from Kathal Bagan, got admitted to DMCH on 3 rd January 2026, with the complains of - PRESENTATION Altered level of consciousness for 1 hour Vomiting 4 hours back

History of alcohol intake with three friends about six hours prior to presentation, after which he developed dizziness, had one episode of vomiting, and altered consciousness. He was found on the street and brought to DMCH. On further enquiry, he reported tremulousness of vision without any associated blurring & gave history of occasional alcohol ingestion for last 1 year No history of exposure to any other toxin or any illicit drug abuse, GI disturbance, epigastric pain or chest pain

INVESTIGATIONS

Immediately after admission: ABG High anion gap metabolic acidosis Fluid trial was started & ABG was repeated after fluid trial: No definite improvement following fluid trial

PARAMETE

RS

VALUE

pH 7. pCO 2

mmHg HCO 3

mmol/L Base Excess

mmol/L Anion Gap 27.

PARAMETE

RS

VALUE

pH 7. pCO 2

mmHg HCO 3

mmol/L Base Excess

mmol/L Anion Gap 21.