Case-4 59M admission 09/01/24

59 years male admission -09/01/24 discharge 12/01/24 Diagnosis CHRONIC DECOMPENSATED ALCOHOLIC LIVER DISEASE WITH THROMBOCYTOPENIA Case History and Clinical Findings C/O B/L PEDAL EDEMA SINCE 5DAYS FACIAL PUFFINESS 4DAYS TREMORS IN B/L UPPER LIMBS SINCE 1YR CHEST THIGHTNESS SINCE 10DAYS PT WAS APPARENTLY ASYMPTOMATIC 5DAYS BACK THEN HE DEVELOPED B/L PEDAL EDEMA PITTING TYPE UPTO KNEE INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE AGGRAVATED ON WALKING AND NO RELIEVING FACTORS A/W FACIAL PUFFINESS SINCE 4 DAYS H/O TREMORS SINCE 1YR H/O CHEST THIGHTNESS SINCE 10DAYS NO SIMILAR COMPLAINTS IN PAST NO KNOWN COMORBIDITIES. \ PALLOR, ICTERUS, CUBBING, CYANOSIS, LYMPHADENOPATHY,EDEMA- ABSENT VITALS- TEMPERATURE AFEBRILE RR-24CPM PR- 72BPM BP-90/60MMHG SPO2-95% SYSTEMIC EXAMINATION: CVS- S1 S2 HEARD, NO ADDED MURMURS. RS- BAE+, NORMAL VESICULAR BREATH SOUNDS CNS - NO FOCAL NEUROLOGICAL DEFICIT. P/A- SOFT, NON TENDER, NO ORGANOMEGALY. USG DONE ON 9/1/24 COARSE ECHOTEXTURE OF LIVER WITH IRREGULAR SURFACE MILD ASCITES F/S/O CHRONIC LIVER DISEASE GASTRO REFERAL WAS DONE ON 12/1/24 ADV: TAB NUSAM 400MG Investigation NameValueRangeNameValueRangeCOMPLETE URINE EXAMINATION (CUE) 09-01-2024 11:15:AM COLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNilSUGARNilBILE SALTSNilBILE PIGMENTSNilPUS CELLS2-3EPITHELIAL CELLS1-2RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilLIVER FUNCTION TEST (LFT) 09-01-2024 11:16:AM Total Bilurubin1.54 mg/dl1-0 mg/dlDirect Bilurubin1.32 mg/dl0.2- 0.0 mg/dlSGOT(AST)53 IU/L35-0 IU/LSGPT(ALT)23 IU/L45-0 IU/LALKALINE PHOSPHATE490 IU/L128-53 IU/LTOTAL PROTEINS8.5 gm/dl8.3-6.4 gm/dlALBUMIN3.25 gm/dl5.2-3.5 gm/dlA/G RATIO0.62RFT 09-01-2024 11:16:AM UREA39 mg/dl42-12 mg/dlCREATININE1.0 mg/dl1.3-0.9 mg/dlURIC ACID5.2 mg/dl7.2-3.5 mg/dlCALCIUM9.8 mg/dl10.2-8.6 mg/dlPHOSPHOROUS3.2 mg/dl4.5-2.5 mg/dlSODIUM138 mEq/L145-136 mEq/LPOTASSIUM3.6 mEq/L5.1-3.5 mEq/LCHLORIDE102 mEq/L98-107 mEq/LCOMPLETE URINE EXAMINATION (CUE) 09-01-2024 05:57:PM COLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNilSUGARNilBILE SALTSNilBILE PIGMENTSNilPUS CELLS2-3EPITHELIAL CELLS2-3RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilHBsAg-RAPID09- 01-2024 05:57:PMNegative Anti HCV Antibodies - RAPID09-01-2024 05:57:PMNon Reactive T3, T4, TSH 09-01-2024 06:47:PM T30.86 ng/ml1.87-0.87 ng/mlT48.86 micro g/dl12.23-6.32 micro g/dlTSH4.13 micro Iu/ml5.36-0.34 micro Iu/mlBLOOD UREA10-01-2024 10:18:PM26 mg/dl42-12 mg/dlSERUM CREATININE10-01-2024 10:18:PM1.6 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 10-01-2024 10:18:PM SODIUM140 mEq/L145-136 mEq/LPOTASSIUM4.0 mEq/L5.1-3.5 mEq/LCHLORIDE104 mEq/L98-107 mEq/LCALCIUM IONIZED1.20 mmol/Lmmol/L Treatment Given(Enter only Generic Name) INJ THIAMINE 200MG IV/BD IN 100ML NS INJ PAN 40MG IV/OD TAB LACILACTONE 20/50 PO/BD TAB UDILIV 300MG PO/OD SYP LACTULOSE 10ML PO/BD Advice at Discharge TAB BENFOMATE FORTE 200MG PER ORAL ONCEDAILY X 5 DAYS TAB PAN 40MG PER ORAL ONCE DAILY X 5 DAYS TAB LACILACTONE 20/50 PER ORAL TWICE DAILY X 5 DAYS TAB UDILIV 300MG PER ORAL ONCE DAILY X 5 DAYS TAB NUSAM 400MG PER ORAL TWICE DAILY X 5 DAYS SYP LACTULOSE 10ML PER ORAL TWICE DAILY Follow Up FOLLOW UP AFTER 1 WEEK OR SOS