keracunan herbisida pada perempuan 57 tahun di RS Kartika Husada

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1. Laporan kasus Glyphosate poisoning Disusun Oleh: Riski Nurfita Sari (I4061202014)

2. Nama : Ny. MA Jenis kelamin : Perempuan Usia : 57 Tahun Alamat : Dsn Koasa 1/3 Bengkarek , Sungai Ambawang , Kubu Raya Agama : Kristen Tgl pemeriksaan : 16 Februari 2023 pukul 10.50 WIB IDENTITAS PASIEN

3. ANAMNESIS Keluhan Utama : Penurunan kesadaran post meminum racun rumput RPS: Pasien Pr 57 tahun dibawa ke IGD RS Kartika Husada setelah meminum racun rumput merk “Roundup” ± 4 jam SMRS. Racun rumput yang diminum kurang lebih sebanyak 500 cc. Keluarga pasien mengatakan setelahnya pasien diberikan susu beruang sebanyak 3 kaleng dan pasien muntah beberapa kali. Saat sampai di IGD pasien mengalami penurunan kesadaran .

4. Primary Survey Look : sumbatan jalan nafas (-), sianosis (-) Feel : deviasi trakea (-), penggunaan otot tambahan (-) Listen : snoring (-), gurgling (-), stridor (-) Airway: clear A Frekuensi nafas : 24 x/ menit SpO2 : 98% tanpa oksigen Gerakan thorax : simetris , retraksi (-) Breathing: spontan B C D Nadi kuat angkat HR : 137x/ menit TD : 149/102 mmHg Akral : Hangat CRT : < 2 detik Circulation: unstabil GCS : E4V2M5 Pupil : isokor 3mm/3mm RCL +/+ RCTL +/+ Suhu : 36,5°C

5. Riwayat Penyakit Dahulu : riw gangguan mental disangkal Riwayat Pengobatan : tidak ada riwayat pengobatan dan konsumsi obat rutin Riwayat Alergi : alergi obat dan makanan disangkal Secondary Survey

6. Pemeriksaan fisik Kepala : Normocephal Mata : CA (-/-), SI (-/-) Hidung : Sekret (-), perdarahan (-) Mulut : Hipersalivasi , sianosis (-) Telinga : Sekret (-) Leher : : pembesaran KGB (-) Thoraks : Gerak dada simetris Pulmo : SND ves +/+, Rh -/- Wh -/- Cor : S1 S2 regular, murmur (-), gallop (-) Abdomen : Soepl . Bising usus (+) normal Ekstremitas : Akral hangat , CRT <2 detik , edema -/-

7. PEMERIKSAAN PENUNJANG PARAMETER HASIL NILAI RUJUKAN SATUAN DARAH LENGKAP WBC 1 6,3 3.50 – 10.0 10 9 / L RBC 4,65 3,50 - 5.50 10 12 / L HGB 12,8 11,5 - 16.5 gr/dL HCT 39,1 35,0 - 55.0 % PLT 308 150 – 400 10 9 / L LYM% 38,0 15,0 – 50,0 % GRA% 58,9 35,0 – 80,0 % MID% 3,1 2,0 – 15,0 % GDS 293 100 – 180 mg/dL SGOT/AST 40 < 40 u/l SGPT/ALT 19 < 41 u/l Ureum 49 15 – 45 mg/dL Creatinin 8,61 0,6 – 1,1 mg/dL Laboratorium (16 Februari 2023, Pukul 11:33)

8. DIAGNOSIS Intoksikasi Herbisida AKI renal Cardiac Arrest Pasang NGT, kumbah lambung IVFD RL 14 tpm Inj. Omeprazole 2x40mg IV Inj. Ondansetron 3x4mg IV Pukul 11.05 pasien henti napas dan henti jantung RJP 3 siklus EKG akhir true asystole Pasien dinyatakan meninggal dunia pukul 11.35 WIB dihadapan keluarga TATALAKSANA

9. The general approach to the poisoned patient can be divided into six phases: S tabilization; Clinical evaluation and definitive diagnosis; D econtamination of the gastrointestinal tract, skin, or eyes; A dministration of an antidote; E limination enhancement of the toxin; and O bservation and disposition. Emergency Management of Poisoning. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 2007;13-61.

10. Anamnesis Bagaimana cara racun masuk / terpapar ke dalam tubuh ? Berapa jumlah racun yang sudah masuk / terpapar ? Sudah berapa lama kontak dengan racun ? Pertolongan pertama apa yag sudah diberikan ? Bagaimana kondisi psikologi penderita ? Gejala apa saja yang telah dialami penderita ? Clinical evaluation and definitive diagnosis

11. Clinical evaluation and definitive diagnosis Emergency Management of Poisoning. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 2007;13-61.

12. Clinical evaluation and definitive diagnosis

13. In every significant poisoning, routine studies include a complete blood count; determination of serum electrolytes, glucose, BUN, creatinine, and calcium; urinalysis; prothrombin time; pulse oximetry; end-tidal CO2 monitoring, and 12-lead electrocardiography. A urinalysis is necessary . Performing a urine pregnancy test is wise in all women of childbearing age. Urine is the best specimen to use for “drug screening” purposes. A urinalysis is also useful in the early identification of acute renal failure or rhabdomyolysis with myoglobinuria. Chest radiography is an aid for diagnosing aspiration pneumonia or pulmonary edema. Clinical evaluation and definitive diagnosis Emergency Management of Poisoning. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 2007;13-61.

14. Emergency Management of Poisoning. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 2007;13-61.

15. E limination enhancement of the toxin; and The four most clinically useful means of elimination enhancement are Activated charcoal Hemodialysis Hemoperfusion Urine alkalinization Emergency Management of Poisoning. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 2007;13-61.

16. Glyphosate is a non-selective herbicide, widely used in agriculture, forestry, industrial weed control and aquatic environments. Proposed mechanisms of glyphosate surfactant herbicide ( GlySH ) toxicity to mammals include uncoupling of oxidative phosphorylation and glyphosate mediated direct cardiotoxicity . It can cause a wide range of clinical manifestations in human beings from skin and throat irritation to hypotension and death. Bahan aktif yang dikandung dalam roundup adalah Isopropil amina glifosat 480 g/l ~ glifosat 356 g/l Mahendrakar, Kranthi , et al. "Glyphosate surfactant herbicide poisoning and management."  Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine  18.5 (2014)

17. There is no antidote for GlySH and treatment is supportive . The mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy . Gastric lavage or activated charcoal can be administered in patients who present <1 h after ingestion and who have no evidence of buccal irritation or burns. There is no evidence , however, that either of these reduce the systemic absorption of GlySH . Mahendrakar, Kranthi , et al. "Glyphosate surfactant herbicide poisoning and management."  Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine  18.5 (2014)

18. Severe poisoning causes dehydration, hypotension, pneumonitis, oliguria, altered level of consciousness, hepatic dysfunction, acidosis, hyperkalemia and dysrhythmias Patients developing acute kidney injury , hyperkalemia , pulmonary edema and metabolic acidosis are more likely to die. Mahendrakar, Kranthi , et al. "Glyphosate surfactant herbicide poisoning and management."  Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine  18.5 (2014)

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