In a tragic turn of events, a 28-year-old woman named Mrs. Radha (name changed) succumbed to a severe case of liver failure after ingesting rat poison disguised as ice cream.
By Dr Ibrahim
Mrs. Radha (name changed) was a 28-year-old woman who arrived at our hospital presenting with a troubling history of recurrent vomiting and jaundice that had persisted for just one day. Her medical history was devoid of any viral prodrome, fever, or ingestion of any potentially offending drugs. Upon examination, she was alert and oriented but exhibited mild jaundice.
A thorough systemic examination revealed no abnormalities. An abdominal ultrasound was performed, which did not indicate any obstruction within the biliary system. All routine investigations were carried out, and the patient was initially placed on supportive treatment.
Despite the supportive care, her condition showed mild elevations in bilirubin and liver enzymes. However, the real concern emerged when her International Normalized Ratio (INR), a measure of blood coagulation, was found to be four times the upper limit of normal. This indicated a severe impairment of liver function, leading to a diagnosis of fulminant liver failure. Consequently, she was admitted to the Intensive Care Unit for closer monitoring and management.
The cause of her jaundice and elevated INR baffled the medical team. Then, at around 8 p.m., an urgent call from the central laboratory alerted the resident doctor on duty. The technician reported, “Doc! Mrs. Radha’s INR has further prolonged and now stands at 18 times the normal value.” A repeat blood test confirmed this alarming coagulation derangement.
Concerned about the risk of spontaneous internal bleeding due to such a high INR, the resident doctor reached out to the head of the department. “Dr. Ibrahim, are you home? We need to see Mrs. Radha together,” Professor Prasad, the head of the department, said in a phone call around 9 p.m.
I quickly changed and headed to the hospital, which was a short walk from my residence. Professor Prasad, who had already examined Mrs. Radha earlier in the day, was also deeply troubled by the escalating INR levels. Despite the hospital being a 10 km drive from his home, he made his way to the facility to assist.
Upon arriving at the ICU, we gathered near Mrs. Radha’s bed and began discussing possible causes for her condition, yet the diagnosis remained elusive. Professor Prasad approached Mrs. Radha with a compassionate demeanor. Gently placing his hand on her forehead, he asked, “My dear, has your vomiting settled?”
“Yes, doctor, I feel better now,” she replied.
“Did you take any medication before coming here? We’re struggling to find a clue to your illness.”
“No, doctor,” Mrs. Radha answered.
“Doctor, do you perform kidney transplants here?” Mrs. Radha inquired.
“Yes, we do,” replied Professor Prasad. “But why are you asking? You don’t need a kidney transplant.”
“I want to donate my kidney to cover the hospital dues because we are poor,” Mrs. Radha said, her voice breaking as tears welled in her eyes. “I don’t want to be a burden on anyone.”
Confused but sympathetic, Professor Prasad urged her to continue, “Please tell us more. We are here to help you.”
Mrs. Radha, sobbing, revealed, “My husband is an alcoholic, and I’m exhausted from his behavior. When he’s drunk, he beats me and tortures me. Yesterday, I bought an ice cream from the market and mixed it with rat poison. I consumed the entire ice cream. I know I am dying, and I request you not to inform my family.”
The revelation left us in stunned silence. The cause of her high INR was now clear, but the prognosis was grim. Rat poison is a known toxin that invariably leads to death. Every passing minute brought her closer to the inevitable.
With the gravity of her condition apparent, we realized that only a liver transplant could potentially save her. However, given the critical state of her INR and the scarcity of potential liver donors, the chances of a successful intervention were slim. The additional burden of her family’s poverty only compounded the challenge.
We proceeded to the counseling room to break the tragic news to her parents and husband. Despite our efforts, Mrs. Radha succumbed to her condition days later, her final ice cream becoming a symbol of her tragic fate.
This case underscores the critical need for an empathetic approach in clinical encounters. The devastating effects of alcoholism, despite its significant revenue for governments, highlight the urgent need to address domestic violence and identify individuals with suicidal tendencies. Recognizing these signs and intervening before a crisis occurs is essential in preventing such heartbreaking outcomes.
The views expressed in this article are solely those of the author and do not necessarily reflect the opinions or views of this Magazine.
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