Case no. 5 41M admission 21/3/24

Case no. 5 41M admission 21/3/24 discharge 23/3/24 follow up - patient expired Diagnosis SEPTIC SHOCK WITH MODS WITH DIC ALTERED SENSORIUM SECONDARY TO HEPATIC ENCEPHALOPATHY ALCOHOLIC LIVER DISEASE SEVERE ANEMIA SECONARY TO ? GI BLEED S/P ENDOTRACHEAL INTUBATION [DAY-0] ON MECHANICAL VENTILATION Case History and Clinical Findings PT WAS BROUGHT TO CASUALITY IN ALTERED STATE SINCE YESTERDAY MORNING PT WAS APPARENTLY ASSYMPTOMATIC UNTILL YESTERDAY MORNING DEVELOPED ALTERED SENSORIUM , INSIDIOUS ONSET , NOT ORIENTED TO TIME , PLACE , PERSON , CONSCIOUS , NON COOPERATIVE H/O VOMITING 2 EPISODES , GREENISH COLOUR H/O LOOSE STOOL, SINCE 2 DAYS , 4 EPISODES WATERY CONSISTENCY H/O LOSS OF APPETITE SINCE 2 DAYS , H/O INADEQUATE SLEEP SINCE SINCE 3 DAYS NO H/O FEVER , NO H/O DECREASED URINE OUTPUT NO H/O SEIZURE ACTIVITY K/C/O ALCOHOLIC LIVER DISEASE WITH PORTAL HYPERTENSION SINCE 9 MONTHS , STOPPED MEDICATION 10 DAYS BACK N/K/C/O DM, HTN , TB , EPILEPSY , ASTHMA GENERAL EXAMINATION PT CONSCIOUS , INCOHERENT , NON COOPERATIVE AFEBRILE PR-94BPM BP- 130/90 MMHG CVS- S1S2 + RS - BAE + CNS - R L TONE UL + + LL + + POWER - COULDNT ELICIT REFLEXES B +2 +2 T +2 +2 S +2 +2 K +3 +3 A +1 +`1 P E E PUPIL - REACTIVE TO LIGHT COURSE IN HOSPITAL 41 YR OLD MALE WAS BROUGHT TO CASUALITY IN ALTERED STATE , VITALS AT THE TIME OF ADMISSION PT CONSCIOUS , INCOHERENT , NON COOPERATIVE , PR -94BPM , BP- - 130/70 MMHG , GRBS- 139 MG/DL , SPO2 - 98% ON RA , PT WAS EVALUATED ACCORDINGLY AND DIAGNOSED AS ALTERED SENSORIUM SECONDARY TO ALCOHOLIC LIVER DISEASE , PT WAS TREATED ACCORDINGLY COAGULATION PROFILE WAS DERANGED SO 6. PACKETS OF FFP WERE TRANSFUSED AND DUE TO FALLING HB 1 PACKET PRBC WAS TRANSFUSED , MRI WAS DONE I/V/O INTRACRANIAL HEMORRHAGES NO ABNORMALITY WAS DETECTED ,ON DAY 3 MORNING ENDOTRACHEAL INTUBATION WAS DONE I/V/O FALLING SATURATIONS AND LOW GCS AND TREATMENT WAS CONTINUED ACCORDINGLY . PT ATTENDERS WERE EXPLAINED ABOUT THE CONDITION OF THE PT AND NEED FOR FURTHER TREATMENT AND STAY IN THE HOSPITAL BUT PT ATTENDERS ARE NOT WILLING TO STAY AND WANT TO LEAVE AGAINST MEDICAL ADVICE . Investigation POST LUNCH BLOOD SUGAR 21-03-2024 11:33:AM 134 mg/dl 140-0 mg/dlSERUM CREATININE 21-03-2024 11:33:AM 1.0 mg/dl 1.3-0.9 mg/dlBLOOD UREA 21-03-2024 11:33:AM 70 mg/dl 42-12 mg/dlLIVER FUNCTION TEST (LFT) 21-03-2024 11:33:AMTotal Bilurubin 19.30 mg/dl 1-0 mg/dlDirect Bilurubin 10.4 mg/dl 0.2-0.0 mg/dlSGOT(AST) 411 IU/L 35-0 IU/LSGPT(ALT) 115 IU/L 45-0 IU/LALKALINE PHOSPHATASE 201 IU/L 128-53 IU/LTOTAL PROTEINS 6.1 gm/dl 8.3-6.4 gm/dlALBUMIN 3.0 gm/dl 5.2-3.5 gm/dlA/G RATIO 0.96HBsAg-RAPID 21-03-2024 11:33:AM NegativeAnti HCV Antibodies - RAPID 21-03-2024 11:33:AM Non ReactiveSERUM ELECTROLYTES (Na, K, C l) 21-03-2024 11:35:AMSODIUM 134 mmol/L 145-136 mmol/LPOTASSIUM 4.0 mmol/L 5.1-3.5 mmol/LCHLORIDE 103 mmol/L 98-107 mmol/LCOMPLETE URINE EXAMINATION (CUE) 21-03-2024 06:54:PMCOLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN NilSUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 10-20EPITHELIAL CELLS 3-4RED BLOOD CELLS loadedCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Bacteria seenLIVER FUNCTION TEST (LFT) 22-03-2024 12:07:AMTotal Bilurubin 19.62 mg/dl 1-0 mg/dlDirect Bilurubin 14.22 mg/dl 0.2-0.0 mg/dlSGOT(AST) 325 IU/L 35-0 IU/LSGPT(ALT) 114 IU/L 45-0 IU/LALKALINE PHOSPHATASE 190 IU/L 128-53 IU/LTOTAL PROTEINS 6.1 gm/dl 8.3-6.4 gm/dlALBUMIN 3.08 gm/dl 5.2-3.5 gm/dlA/G RATIO 1.02STOOL FOR OCCULT BLOOD 22-03-2024 12:08:AM Positive (+ve)COMPLETE URINE EXAMINATION (CUE) 22-03-2024 04:18:PMCOLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN NilSUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-3EPITHELIAL CELLS fewRED BLOOD CELLS 4-5CRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Bacteria seenBLOOD UREA 22-03-2024 11:46:PM 113 mg/dl 42-12 mg/dlSERUM CREATININE 22-03-2024 11:46:PM 1.4 mg/dl 1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 22-03-2024 11:46:PMSODIUM 139 mmol/L 145-136 mmol/LPOTASSIUM 3.1 mmol/L 5.1-3.5 mmol/LCHLORIDE 98 mmol/L 98-107 mmol/LLIVER FUNCTION TEST (LFT) 22-03-2024 11:46:PMTotal Bilurubin 19.81 mg/ dl 1-0 mg/dlDirect Bilurubin 12.85 mg/dl 0.2-0.0 mg/dlSGOT(AST) 299 IU/L 35-0 IU/LSGPT(ALT) 111 IU/L 45-0 IU/LALKALINE PHOSPHATASE 125 IU/L 128-53 IU/LTOTAL PROTEINS 5.5 gm/dl 8.3-6.4 gm/dlALBUMIN 2.88 gm/dl 5.2-3.5 gm/dlA/G RATIO 1.10ABG 23-03-2024 03:24:AMPH 7.382PCO2 16.6PO2 110HCO3 9.6St.HCO3 12.3BEB -15.1BEecf -14.7TCO2 21.9O2 Sat 98.6O2 Count 4.6ABG 23-03-2024 09:20:AMPH 7.39PCO2 19.2PO2 222HCO3 11.4St.HCO3 14.0BEB -12.9BEecf - 12.6TCO2 25.8O2 Sat 99.7O2 Count 5.8 CBP-21/3/24 HB- 6.2 TC- 7200 PCV- 16.9 CBP- 22/3/24 HB- 4.8 TC- 6000 PLT-40000 LDH- 139 RETIC COUNT- 0.9 TROP I - 48.6 USG- ABDOMEN AND PELVIS PORTAL HYPERTENSION MILD SPLENOMEGALY GRADE 2 FATTY LIVER MILD ASCITES [ FEW MESENTRIC COLLATERALS NOTED IN RT HYPOCHONDRIUM ] 2D ECHO NO RWMA EF-68% GOOD LV SYSTOLIC FUNCTION NO DIASTOLIC DYSFUNCTION IVC - 1.08 COLLAPSING SCLEROTIC AV MRI - BRAIN - NO ABNORMALITY DETECTED SERUM LACTATE -23.3 Treatment Given(Enter only Generic Name) GIVEN RT FEEDS 2ND HRLY IVF NS @ 50 ML/HR INJ . NORAD 10.16 MGS /ML @ 12 ML /HR TO MAINTAIN MAP >65 INJ. DOBUTAMINE 15 MG ML @ 3.2 ML /HR TO MAINTAIN MAP INJ.VASOPRESSIN 2ML /HR INJ . CEFOTAXIME 2GM IV BD INJ VIT K 1 AMP IV OD INJ .MEROPENEM IV 1GM BD INJ. METROGYL IV TID INJ.PAN 40 MG IV /OD INJ .THIAMINE 250 G IV BD INJ. ATRACURIUM [1MG/ML] @ 5 ML /HR INJ. TRANEXAMIC ACID 1GM IV BD INJ . OCTREOTIDE 50 MG IV TIA T.RIFAGUT 550 MG RT BD T.UDILIV 300 MG RT BD T.CARDIVAS 3.125 MG RT OD SYP .LACTULOSE 15 MG RT BD SYP. HEPAMERZ 20 ML RT TID Advice at Discharge PT ATTENDERS HAVE BEEN EXPLAINED ABOUT THE CONDITION OF PT I.E SEPTIC SHOCK WITH MODS WITH DIC . ALTERED SENSORIUM SECONDARY TO HEPATIC ENCEPHALOPATHY , ALCOHOLIC LIVER DISEASE , SEVERE ANEMIA S/P ET INTUBATION [ DAY-0] ON MECHANICAL VENTILATION AND COMPLICATION A/W IT I.E RISK OF DEATH , AND NEED FOR FURTHER MANAGEMENT AND HOSPITAL STAY . BUT PT ATTENDER ARE NOT WILLING TO STAY AND WANT TO LEAVE AGAINST MEDICAL ADVISE ,. DOCTOR AND HOSPITAL ARE NOT RESPONSIBLE FOR ANY UNTOWARD EVENT