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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