30 year old male with ALI, AKI and MI

 




A 30 year old male patient who is from Suryapet and a farmer by occupation presented to the OPD on 29/11/22 with 

Chief Complaints of 

•Vomitings and abdominal discomfort since 3 days

•SOB since 3 days

HOPI-

The patient was apparently asymptomatic 12 days back(19th November'22) then he developed Yellowish discoloration of eyes which was associated with facial puffiness first and followed by pedal edema which was pitting type.

Then on 23rd he went to a private hospital where he was investigated and was diagnosed to have jaundice.

On 24th he took a herbal medicine(Plants unknown) of 100 ml (half of a disposable glass) . 

On 25th he developed Vomitings which were sudden in onset, 2 to 3 episodes per day initially which eventually progressed to 6 to 7 episodes per day on the day of presentation. Content was bilious vomiting (green in color) with no aggravating and relieving factors. Patient was on complete liquid diet during these 3 days.

Vomitings were associated with diffuse abdominal pain, and fever.

Fever was continuous, with evening rise of temperature and no aggravating and relieving factors.(Not associated with chills and rigor).

Patient also gave history of SOB grade 2 to 3 and Dry non productive cough.

Patient gave a history of Weight loss (>15 kgs) in the last 2 months.

Past History -

Not a K/c/o DM, HTN, TB, Asthma, Epilepsy and CAD.

Personal History -

Appetite - Decreased since 10 days

Diet- Mixed

Bowel and Bladder- Regular

Sleep- Adequate

Addictions- Used to drink alcohol once a week but since 2 months he started consuming alcohol everyday. (Whiskey- 90ml) Last binge 20 days back.

Daily routine



Drug History - Not Significant 

Treatment History - Not Significant 

No known allergies.

General Examination:

Patient is conscious coherent and cooperative, well oriented to time,place and person.

Thin built and moderately nourished



Pallor: Absent





Pedal edema subsided



No signs of Icterus cyanosis, clubbing , Lymphadenopathy.


Vitals

Temp:

PR: 90 bpm

Bp: 120/70 mmHg 

RR: 20 cpm

Systemic Examination:

CVS:

S1 heard

Loud P2 .

RS:

Trachea central

Normal vesicular breath sounds heard

Abdomen:

No tenderness 

No distension 

Liver and spleen not palpable

Bowel sounds - Normal

CNS- No neurological focal deficit

Investigations-

Fever chart-









ECG at the time of admission 


Complaints on Day 3 post admission of tightness of chest and chest pain

Repeat ECG as on 2nd Dec


2D Echo Repeat as on 2nd Dec




Treatment -

Inj Monocef 1gm/Iv/BD
Tab. Udicliv 300mg/Po/BD
Tab. Zofer 4mg/BD
Inj. Thiamine 
Inj. Pantop 40 mg/Iv/OD
Syp. Lactulose 10ml/Po/BD

After MI
Clopidogrel 300mg
Atorvastatin 75mg
Ecosprin 300mg

Provisional Diagnosis

• Acute liver Injury

• Acute kidney Injury

• MI

•? Sepsis











Comments

Post a Comment

Popular posts from this blog

Image
4)Case based OSCE along with BLOOM’S learning levels Achieved  It all started when I was asked to send for the investigations of a 35 year old female who was taken over from the department of Dermatoloy on my OP day. I reluctantly went up as I was already on a roll with the 36hr shifts I had to take. But then as I went to the patient I was filled with compassion for that Thin and undernourished patient who was going through a lot!!  A 35 year old female presented with C/o painful skin lesions over arms, legs, back since 2 months -C/o Fever and Burning Micturition since 4 days HOPI- Patient was apparently asymptomatic 2 months back then she developed painful skin lesions over arms, legs, back. The lesions were sudden in onset, gradually progressive, with no aggravating and relieving factors. H/o vesicles associated with pus discharge + H/o fever since 4 days, not associated with chills and rigors, no diurnal variation, relieves with medication. H/o burning micturition since 4 days. N
Read more
Image
 A 25 year old male who is a resident of Choutuppal and a driver by occupation came with CC of  Pain and Redspots on the tips, pulp and nailbed of fingers (Rt hand) since 4 days ✓HOPI- The patient was apparently asymptomatic one and a half month back then he had burning sensation in the epigastric region aggravated on having heavy and spicy food. Associated with bloating after intake of food and abdominal tightness. For which he got treated by a local doctor ( Pantop-D for 6 days) Then 4 days back he had dragging type of pain which was sudden in onset and aggravated on doing work and relieved on rest. No H/o trauma. There are Redspots on the tips,pulp,nailbed of fingers of Right UL. ✓Past History - N/k/c/o DM, HTN, TB, Asthma, Epilepsy ✓Personal History- Appetite - Reduced Diet- Mixed Bowel and Bladder-Regular Sleep- Adequate Addictions - Nil ✓Family History - Not Significant ✓On Examination- Patient is conscious and coherent. Thin built and well nourished. Vitals Temp- Afebrile  PR- 9
Read more
Image
2)  Evidence based date wise workflow logs collated by the intern with clickable and verifiable links  Case 1 https://chat.whatsapp.com/LeUjoFdD9rnGmrmTBrAr8c  [31/08/23, 10:33:04 AM] Cherish Kandru: soap notes  31:8:23  ICU Bed 3 Dr.ZainSR) Dr.Haripriya(PGY2) DR.Govardhini(PGY1) S: No Fever Spikes O: Pt is Sedated and Intubated GCS- E1V1M1 PR-80bpm RR-15cpm BP-60/40 mmhg @20ml/hr NORAD @14ml/hr DOBU ACMV Mode FiO2 @70 SPO2 98% RS: BLAE + NVBS CVS: S1S2 +, No murmurs CNS:  Tone :Normal B/L both UL&LL Power :  Unable to elicit Reflexes: Absent B/L in both UL & LL I/O 1900/200ml GRBS 327mg/DK A: 3 weeks old L5 burst Fracture & Unstable with PLC injury Planned for L4-L5 S1 Fixation with Heart Failure with Reduced Ejection Fraction (44%) with k/c/o DM since 20 years, k/c/o CAD (PTCA done) 2 years back P:  1. INJ NORADRENALINE 4ml + 46ml NS @ 10 ml/ hr  2. INJ DOBUTAMINE 1AMP (5ml) + 45ml NS @ 10 ml /hr  3. INS 3% NACL @ 50 ml/hr I.V /stat 4. INJ PIPTAZ 2.25 gm IV/TID  5
Read more