Tugas Mandiri-1

Topik: Paparan dan Efek yang tidak diinginkan

Indikator Capaian:
1. Memahami (C2) pengaruh rute, frekuensi dan durasi paparan terhadap efek yang tidak diinginkan
2. Menganalisa (C4) kasus toksikologi dan menerapkan (C3) konsep toksikologi dalam menjawab
permasalahan

Studi Kasus
Case report 1: Hypoglikemia akibat Glibenklamid pada geriatri
A 77-year-old gentleman presented to the general practitioner (GP) with complaints of fever, loose motions
and drowsiness of 1-day duration. His fever was low grade, intermittent and not associated with rigors and
chills. He had experienced four episodes of watery stools during the previous 24 hours with no associated
vomiting. The patient was drowsy, aphasic, did not recognize his family members and was unable to walk. The
local GP found him to be hypoglycaemic with a blood sugar of 45 mg/dl. He was managed with dextrose
and referred to the hospital.
There was no history of decreased food intake. The patient had been taking normal diet, appropriate for
culture and locality, that is, naan(bread), a staple in the diet taken three times daily with beans, pulses or
meat with vegetables. This patient had been increasingly hungry due to recurrent hypoglycaemia in the
preceding weeks and was eating more than usual. The patient was a diagnosed case of hypertension, renal
parenchymal disease (grade I) and type II diabetes mellitus, and had been taking the tablet form of
glibenclamide, 5 mg twice a day for the past 5 years, amlodipine besylate, 5 mg occasionally, and dutasteride
and tamsulosin combination for his benign prostatic hyperplasia.
The patient was brought immediately to the hospital. He was placed on 3 hourly blood glucose monitoring
record (Figure 1) and was started on IV 5% dextrose along with normal saline. Once the patient became
normoglycaemic and was able to maintain it for a period of 24 hours without any IV fluids, he was
discharged with a plan to follow up in 1 week with blood glucose readings.

Sumber: Hussain A, Ali I, Khan AU, Khan TM. Glibenclamide-induced profound hypoglycaemic crisis: a case
report. Ther Adv Endocrinol Metab. 2016;7(2):84–7.

Case report 2: Percobaan bunuh diri menggunakan insektisida

An eighteen-year-old woman was brought to the Emergency Department (ED) of a tertiary level hospital in a
largely agricultural region of Nepal with an alleged history of chlorpyriphos poisoning. She had injected herself
with the compound. At the time of presentation, it was uncertain whether the patient gave herself an
intravenous, subcutaneous, or intramuscular dose of chlorpyriphos.However, as a professional paramedic it is
likely that shewas attempting intravenous administration since she had the expertise and access to syringes
and needles.
After 12 hours of symptom-free interval, she developed swelling at the injection site. The injection site was
warm to touch and erythematous, but without fluctuance. Even though there was no fever, a diagnosis
ofcellulitis, combined with irritant dermatitis due to the hydrocarbon component of the OP solvents, was
suspected.
The exposure reportedly occurred 24 hours prior topresentation, during an attempted suicide. She had pre-
sented with a few episodes of vomiting and lacrimation at the rural hospital. Her initial management for the
poisoning was done with atropine and pralidoxime (2-PAM). Nasogastric suction and Foley catheterisation was
done atthe rural district hospital. Intravenous access was secured. She was then referred for higher level of
intensive care toa tertiary care centre.Her clinical course after that was uneventful. She was discharged
after 12 days of hospitalization. Following her clinical recovery, she was evaluated by psychiatrists and it was
revealed that injection of poison was an impulsive act due to familial disputes. Follow up visit was planned
after 1 week of daily dressing changes and oral antibiotics at home.

Sumber: Malla G, Basnet B, Vohra R, Lohani SP, Yadav A, Dhungana V. Parenteral organophosphorus poisoning
in a rural emergency department: A case report. BMC Res Notes. 2013;6(1):1–4.

Petunjuk Mengerjakan Tugas

1. Bacalah kasus yang telah disediakan diatas, terdapat dua kasus kejadian efek yang tidak
diinginkan. Jika anda menghendaki membaca secara penuh maka anda dapat akses melalui
sumber artikel yang telah kami cantumkan.
2. Lakukan analisa mendalam dan fokus pada pertanyaan yang ditanyakan
3. Tuliskan jawaban anda pada lembar yang sama dengan lembar penugasan ini
4. Kirimkan penugasan dalam bentuk PDF

Pertanyaan
1. Tuliskan perbedaan rute paparan pada kasus diatas !, Manakah yang lebih beresiko, jelaskan
alasannya
2. Berdasarkan kasus diatas, Lakukan telaah dan bandingkan kedua kasus diatas terkait durasi
paparan dan frekuensi paparan !
3. Pada kategori manakah efek yang tidak diinginkan tersebut (baca bahan kuliah terkait Efek
Toksik) !