, Dose supposée ingérée (en mg/kg ou autre, préciser)

, Effets cliniques observés (si personne asymptomatique préciser)

.. , Orientation (service de médecine, réanimation, UHCD

, Durée d'hospitalisation (en heures ou en jours, préciser)

, Résultats biologiques et éventuels dosages réalisés

;. Hémogramme and .. , Taux de prothrombine (+++), ionogramme (éventuellement)

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