A CASE OF 42YEAR OLD MALE k.swarnamukhi -1601006100

​42Year old male presented with complaints of, 

Abdominal pain since 4 Days

Decreased urine output since 4 Days

Constipation since 4 Days

Vomitings since 4 Days

History of presenting illness:

Patient was apparently asymptomatic 4 Days back then he complained of abdominal pain which is diffuse associated with vomitings which is bilious, non-projectile, greenish in color, associated with constipation, passed stools 3Days back. 

Patient also complained of decreased urine output since 3Days.

There is a history of continuous alcohol consumption since 10 Days without intake of food. 

Stiffness of joints yesterday night. 

No loss of consciousness, giddiness, fever. 

Past History:

Not a Known case of DM, HTN, Asthma, Epilepsy, CAD, CVA. 

PERSONAL HISTORY 
diet : mixed 
Appetite : decreasd since 10 days 
Sleep : addequate 
Bowel habits:irregular
bladder habits:regular 
addictions :- h/0 of alcoholic intake since 30 years (sara) 


FAMILY HISTORY : Not significant

ON EXAMINATION : 

Patient  is conscious, coherent, cooperative.
 pallor , clubbing, cyanosis , lymphadenopathy absent. Icterus:Present,B/L pedal edema present pitting type upto ankles. 





VITALS 
Temp- Afebrile 
Bp-100/80 mm hg
Pr- 84bpm
Rr-16cpm
Spo2- 99% on RA

Systemic Examination:
Cardiovascular System : S1, S2 heard, no murmurs

Respiratory System : Bilateral air entry present.Normal vesicular breath sounds heard.Position of trachea central.

Central Nervous System : patient is conscious coherent and cooperative. Higher mental functions intact 

Per abdomen : soft, non tender. No organomegaly.


INVESTIGATIONS :- 

HEMOGRAM 

HB 11.4GM/DL 
TLC #23,200 
N/L/E/M/B. #85/07/#00/08/00
PCV #31.8
MCV 88.6
MCH 31.8
MCHC 35.8
RDW-CV #14.5
RDW-SD #47.7
RBC. #3.59
PLT. 62,000

CUE :- 
ALBUMIN
BILE SALTS AND PIGMENTS   NIL
PUS CELLS   NIL 

LFT :- 
TB  #14MG/DL
DB #13.20MG/DL
SGOT #94 IU/L 
SGPT #50 IU/L 
ALP.   # 224 IU/L
TP  # 4.9gm/dl 
albumin. #2.4gm/dl 
A/G RATIO. 0.96

RFT:
Blood urea #196
Serum creatinine #4.5
Serum electrolytes 
Sodium #119
Potassium #2.6
Chloride #94
Calcium #0.91

ABG:
PH 7.31
Pco2:18.1
Po2:109
Hco3:8.9
St. Hco3:12.5

Blood group:A ve
APTT 35sec
PT:18sec
INR:1.33
ESR:0.5mm/1st hour
LDH #469
Serum osmolality:265.4mosm/kg
Urinary electrolytes:
Sodium 169
Potassium 15
Chloride 180

ECG:

USG Abdomen:


Provisional diagnosis:
Alcohol induced hypokalemia.ALI

Treatment:
Inj. PAN. 40mg iv/OD
Inj. ZOFER 4mg iv/sos
Inj. NEOMOL 1gm iv/sis (if temp>101°f) 
Inj. LASIX 40mg iv/BD
inj. OPTINEURON 1amp in 100ml NS iv/OD
Tab. UDILIX 300mg  BD
SYP. HEPAMERZ 10ml TID
SYP. LACTULOSE 15ml HS
Inj. THIAMINE 200mg in 100ml NS iv/BD





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