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