44 year old with ALD

 

CHIEF COMPLAINTS 

44 year old male came to casualty with chief complaints of fever with chills on and off high grade associated with chills and rigor 

HOPI 

patient was apparently asymptomatic 12 years back had history of intake of alcohol initially 90 ml 

 gradually progress to amount of 200 ml 

since 2 years patient was on alcohol 200 ml ,

quantity increased to daily intake  of with no  or minimal food intake

H/O agressive behaviour 

tremors + 

decreased appetite 

yellowish discoloration of sclera present 

vomiting of 1 episode , patient was admitted in outside hospital and treated as alcoholic liver disease With TB - 23.7 gradually reduced to 2.5  

pain abdomen + 

passing stools (1-2 ) episodes/day 

No loose stools , vomitings,malena ,blood in stools 

Past history 

N/K/C/O - DM, ASTHMA,TB , EPILEPSY

Personal history 

married 

appetite - lost 

bowel - regular 

micturition - normal 

known alcoholic since 12 years 

GENERAL EXAMINATION 

no pallor,icterus,cyanosis, clubbing of fingers ,lymphadenopathy 

dehydration - present 

temperature - febrile

pulse rate - 145 bpm 

bp -90/60 bpm 

spo2 - 98 percent 

grbs - 85 mg %

SYSTEMIC EXAMINATION 

CVS - S1,S2 heard ,no murmurs 

Respiratory system 

BAE + 

P/A - obese , splenomegaly + ,no tenderness 

CNS - NAD , Glasgow scale - 15/15 



                                                                                                    INVESTIGATIONS 

    










PROVISIONAL DIAGNOSIS 

ALD WITH ALCOHOL DEPENDENCE WITH AKI 

Treatment 

Day 1

1) IVF NS @ 5 ML /HR  ,RL,5 %D 

2) INJ PANTOP 40.MG IV/OD 

3)INJ ZOFER 4 MG IV/SOS 

4) INJ NEOMOL 100 ML NS IV / SOS (IF TEMP GREATER 101 F ) 

5) TAB PCM 500 MG.PO/TID 

6) I/O CHARTING 

7)TEMP CHARTING 

8)GRBS 6 TH HOURLY 

9)SYP LACTULOSE 15 ML PO/HS

10)INJ TRAMADOL 1 AMP IN 100 ML NS IV/BD 

11) VITALS 2ND HOURLY

Day 2 


1) IVF NS @ 5 ML /HR  ,RL,5 %D 

2) INJ PANTOP 40.MG IV/OD 

3)INJ ZOFER 4 MG IV/SOS 

4) INJ NEOMOL 100 ML NS IV / SOS (IF TEMP GREATER 101 F ) 

5) TAB PCM 500 MG.PO/TID 

6) I/O CHARTING 

7)TEMP CHARTING 

8)GRBS 6 TH HOURLY 

9)SYP LACTULOSE 15 ML PO/HS

10)INJ TRAMADOL 1 AMP IN 100 ML NS IV/BD 

11) VITALS 2ND HOURLY

12) TAB RIFAGUT 550 MG PO/OD

13)SYP HEPAMERZ 15 ML PO/OD 

14) TAB SPORLAC PO/SOS 

15)INJ VIT K IV/OD 

Day 3


1) IVF NS @ 5 ML /HR  ,RL,5 %D 

2) INJ PANTOP 40.MG IV/OD 

3)INJ ZOFER 4 MG IV/SOS 

4) INJ NEOMOL 100 ML NS IV / SOS (IF TEMP GREATER 101 F ) 

5) TAB PCM 500 MG.PO/TID 

6) I/O CHARTING 

7)TEMP CHARTING 

8)GRBS 6 TH HOURLY 

9)SYP LACTULOSE 15 ML PO/HS

10)INJ TRAMADOL 1 AMP IN 100 ML NS IV/BD 

11) VITALS 2ND HOURLY

12) TAB RIFAGUT 550 MG PO/OD

13)SYP HEPAMERZ 15 ML PO/OD 

14) TAB SPORLAC PO/SOS 

15)INJ VIT K IV/OD 

Day 4 


1) IVF NS @ 5 ML /HR  ,RL,5 %D 

2) INJ PANTOP 40.MG IV/OD 

3)INJ ZOFER 4 MG IV/SOS 

4) INJ NEOMOL 100 ML NS IV / SOS (IF TEMP GREATER 101 F ) 

5) TAB PCM 500 MG.PO/TID 

6) I/O CHARTING 

7)TEMP CHARTING 

8)GRBS 6 TH HOURLY 

9)SYP LACTULOSE 15 ML PO/HS

10)INJ TRAMADOL 1 AMP IN 100 ML NS IV/BD 

11) VITALS 2ND HOURLY

12) TAB RIFAGUT 550 MG PO/OD

13)SYP HEPAMERZ 15 ML PO/OD 

14) TAB SPORLAC PO/SOS 

15)INJ VIT K IV/OD  

Day 5 


1) IVF NS @ 5 ML /HR  ,RL,5 %D 

2) INJ PANTOP 40.MG IV/OD 

3)INJ ZOFER 4 MG IV/SOS 

4) INJ NEOMOL 100 ML NS IV / SOS (IF TEMP GREATER 101 F ) 

5) TAB PCM 500 MG.PO/TID 

6) I/O CHARTING 

7)TEMP CHARTING 

8)GRBS 6 TH HOURLY 

9)SYP LACTULOSE 15 ML PO/HS

10)INJ TRAMADOL 1 AMP IN 100 ML NS IV/BD 

11) VITALS 2ND HOURLY

12) TAB RIFAGUT 550 MG PO/OD

13)SYP HEPAMERZ 15 ML PO/OD 

14) TAB SPORLAC PO/SOS 

Death summary 

6 /1/22 

6 00 PM 

44 year mail came to casualty with chief complaints of fever vomitings pain abdomen yellowish discolouration of sclera 

on presentation patient febrile with tachycardia .patient had history of chronic alcoholism with history and clinical examination and provisional diagnosis was alcoholic  liver disease with alcohol dependence with sepsis and pain abdomen and under evaluation . patient was started on antibiotics and other supportive care .on day three of admission fever spikes continued patient became tachyepnic.  to relieve distress patient was put on intermittent BiPAP x-ray erect abdominal KUB was done showing dilated bowel  loops and left pyelonephritis surgery and neurology opinion was taken accordingly as fever spikes not subsided and blood culture showed Klebsiella antibiotic was escalated on  6 at around 4 PM patient became unresponsive patient was intubated and connected to Ambu bag as peripheral and central pulses are not palpable started on ionotropes 

CPR was initiated and continued for 30 minutes. Despite of all the efforts, patient could not be relieved and declared dead on sixth 2022 at 5:41 PM 

Immediate cause type to respiratory failure with metabolic acidosis refractory

Antecedent cause - left Emphysematous pyelonephritis with ARDS secondary to sepsis with alcoholic liver disease with alcohol and tobacco dependence syndrome 





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