case 8.45 M WITH PAIN ABDOMEN AND SWELLING OF LIMBS

DOA 10/12/2024

EXPIRED ON 30/12/2024

Diagnosis

SEPTIC SHOCK SECONDARY TO SPONTANEOUS BACTERIAL PERITONITIS

DECOMPENSATED CHRONIC LIVER DISEASE WITH OESOPHAGEAL VARICES BLEEDING

HEPATIC ENCEPHALOPATHY GRADE III

ANEMIA OF CHRONIC DISEASE

TYPE II DIABETES MELLITUS WITH DIABETIC RETINOPATHY

CHRONIC NON HEALING ULCER OVER RIGHT LEG

K/C/O Htn SINCE 2 YEARS

CKD ON MHD

Case History and Clinical Findings

C/O PAIN ABDOMEN

H/O UPPER LIMB AND LOWER LIMB EDEMA NO H/O FEVER

H/O OF VOMITINGS WITH 3 EPISODES OF FOOD AS CONTENT

H/O DECREASED URINE OUTUT

H/O OF ULCER OVER RIGHT LOWER LEG SINCE 5 MONTHS HEALING

H/O CONSUMPTION ONCE IN 2 DAYS PASSING FLATUS AND STOOLS

PAST HISTORY:

K/C/O HTN 2 YEAR AND ON MEDICATION TAB TELMA 40 MG PO/OD

K/C/O DM SINCE 10 YRS

N/K/C/O SEIURES ,CAD,CVA,TB ,THYROID DISORDERS, ASTHMA

PERSONAL HISTORY

APPETITE NORMAL

SLEEP ADEQUATE

BOWEL MOVEMENTS REGULAR

DECREASED URINE OUTPUT

ADDICTIONS :NO

FAMILY HISTORY NOT SIGNIFICANT

GENERAL EXAMINATION

PT IS CONCIOUS COHERENT AND COOPERATIVE

NO PALLOR ICTERUS CYANOSIS CLUBBINGLYMPHADENOPATHY

PEDAL EDEMA - PRESENT

VITALS:

TEMPERATURE AFEBRILE

BP 110/70 MM HG

PR 108 BPM

RR 20 CPM

SPO2 99 AT RA

SYSTEMIC EXAMINATION

RS :DYSPNEIC, BAE + NVBS

PA - SOFT,NON TENDER,NO ORGANOMEGALY

CVS - S1S2 HEARD,

CNS -NFND

DAILYSIS SESSION:

12/12//24

04/12/24

16/12/24

21/12/24

24/12/24

27/12/24

Investigation

CBP

HB 9.5

TC 8900

N 72

L 24

E 00

M 04

B 00

PLT 96000

SMEAR NORMOCYTIC NORMOCHROMIC ANEMIA WITH THROMBOCYTOPENIA

LIVER FUNCTION TEST (LFT) 10-11-2024 02:49:PMTotal Bilurubin 1.12mg/dlDirect Bilurubin 0.21

mg/dlSGOT(AST) 22 IU/LSGPT(ALT) 23IU/LALKALINE PHOSPHATASE 1112 IU/LTOTAL

PROTEINS 4 gm/dlALBUMIN 1.19 gm/dlA/G RATIO 0.42

FBS -110 mg/dl

PLBS -73 mg/dl

Hba1C-5.7 %

LIVER FUNCTION TEST (LFT) 25-12-2024 02:49:PMTotal Bilurubin 1.10mg/dlDirect Bilurubin 0.20

mg/dlSGOT(AST) 26 IU/LSGPT(ALT) 19IU/LALKALINE PHOSPHATASE 893 IU/LTOTAL

PROTEINS 4 gm/dlALBUMIN 1 gm/dlA/G RATIO 0.33

Anti HCV Antibodies - RAPID M Non ReactiveHBsAg-RAPID Negative

RFT 10-12-2024 UREA 69 mg/dlCREATININE 5.5 mg/dlURIC ACID 5.1 mmol/LCALCIUM 9.8

mg/dlPHOSPHOROUS 3.3 mg/dlSODIUM 138 mmol/LPOTASSIUM 3.1 mmol/L.CHLORIDE 104

mmol/L

RFT 11-12-2024 UREA 79 mg/dlCREATININE 69 mg/dlURIC ACID 5.2 mmol/LCALCIUM

8.6mg/dlPHOSPHOROUS 3.7 mg/dlSODIUM 138 1131mmol/LPOTASSIUM 3.4 mmol/L.CHLORIDE

106mmol/L

RFT 22-12-2024 UREA 69 102/dlCREATININE 6.8mg/dlURIC ACID 5..5 mmol/LCALCIUM 8.4

mg/dlPHOSPHOROUS 4.2 mg/dlSODIUM 138 mmol/LPOTASSIUM 4.2 mmol/L.CHLORIDE 106

mmol/L

RFT 25-12-2024 UREA 108mg/dlCREATININE 5.9 mg/dlURIC ACID 6 mmol/LCALCIUM 9

mg/dlPHOSPHOROUS 4.3 mg/dlSODIUM 135 mmol/LPOTASSIUM 4.1 mmol/L.CHLORIDE 103

mmol/L

RFT 26-12-2024 UREA 177mg/dlCREATININE 6mg/dlURIC ACID 6.1 mmol/LCALCIUM 8

mg/dlPHOSPHOROUS 4.3 mg/dlSODIUM 136 mmol/LPOTASSIUM 3.8 mmol/L.CHLORIDE 101

mmol/L

RFT 27-12-2024 UREA 72 mg/dlCREATININE 4.1 mg/dlURIC ACID 3.9 mmol/LCALCIUM

7.9mg/dlPHOSPHOROUS 2.91 mg/dlSODIUM 137 mmol/LPOTASSIUM 4.7 mmol/L.CHLORIDE

101mmol/L

RFT 28-12-2024 UREA 78 mg/dlCREATININE 4.4 mg/dlURIC ACID 4.2 mmol/LCALCIUM 7.8

mg/dlPHOSPHOROUS 3.29 mg/dlSODIUM 136 mmol/LPOTASSIUM 2.9 mmol/L.CHLORIDE 104

mmol/L

ABG 28/12/24

PH 7.37 7.35-7.45PCO2 27.7 mmHg 35-45 mmHgPO2 90.8 mmHg 85-95 mmHgHCO3 15.6

mmol/LSt.HCO3 17.4 mmol/LBEB -8.5 mmol/LBEecf -8.6 mmol/LTCO2 34.4 VOLO2 Sat 96.8 %O2

Count 8.2 vol %

ABG 30/12/24

PH 7.31 7.35-7.45PCO2 29.9 mmHg 35-45 mmHgPO2 72.3 mmHg 85-95 mmHgHCO3 14.8

mmol/LSt.HCO3 16.2 mmol/LBEB -10.0 mmol/LBEecf -10.1 mmol/LTCO2 32.9 VOLO2 Sat 91.8 %O2

Count 7.9 vol %

APTT 58 SEC

PT 30 SEC

INR 2.22 SECBLOOD GROUPING AND RH TYPE- B P

RANDOM SUGAR RANDOM - 86MG/DL

SERUM IRON -57.2 UG/DL

USG DONE ON 10/12/24:

IMPRESSION ; GROSS ASCITES

B/L PLEURAL EFFUSION R>L

B/L GRADE II RPD CHANGES

2D ECHO

-NO RWMA. PARADOXICAL IVS

-TRIVIAL TR ; NO PAH (RVSP-36MMHG)

-NO MR/AR ; NO AS/MS

-SCLEROTIC AV ; MV-AML

-EF>55% GOOD LV SYSTOLIC FUNCTION

-GRADE I DIASTOLIC DYSFUNCTION

-IVC SIZE (0.2IMS) COLLAPSING

-MINIMAL PE AND PLEURAL EFFUSION

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION <1.5 L /DAY

SALT RESTRICTION <2 G/DAY

INJ NORAD 2 AMP IN 46 ML NS@ 2.5 ML/HR

INJ MEROPENAM 500 MG IV/BD

INJ ZOFER 4 MG I/BD

INJ TRANEXA 500 MG IV/BD

INJ VITAMIN K 10 MG IN 40 ML NS IV/OD

INJ OCTREOTIDE 100 UG SC/TID

TAB NODOSIS 500 MG PO/OD

TAB SHELCAL CT PO/OD

CAP BIO D3 60000 IUPO/OD

T BACT OINTMENT FOR LA

NEOSPORIN POWDER FOR LA

NEPHROSAVE PROTEIN POWDER

SYP LACTULOSE 30 ML PO/TID

INJ LASIX 20 MG IV/OD

INJ HYDROCORTISONE 100 MG IV/BD

PROCTOLYTIC ENEMA

AIR BED

FREQUENT POSITION CHANGE

CAUSE OF DEATH:-1.SEPTIC SHOCK 2* TO SPONTANEOUS BACTERIAL PERITONITIS

2.HEPATIC ENCEPHALOPATHY (GRADE III)3. CHRONIC DECOMPENSATED LIVER DISEASE

WITH ? OESOPHAGEAL VARICEAL BLEED