MODS with ? DIC secondary to toxin mediated(?alcohol)/ infection(? Bacterial/leptospirosis/viral) with AKI(resolved) with acute liver failure(resolving) with alcohol withdrawalWith thrombocytopenia(resolved)With right sided pleural effusionWith moderate ascitis(low SAAG high protein)



TEJASWINI MARISA(INTERN)

This is online E log book to discuss our patient’s de-identified health data shared after taking   his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problms with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome .


CHIEF COMPLAINTS:
A 20 year old male patient is drowsy since 1.5 hrs
C/o 20-30 episodes of vomiting in the past 2 days
HOPI:
Patient is an occasional alcoholic since last 4 years, who started consuming alcohol regularily since last 3 years(3-4 times a week) since last 20 days. Patient has been drinking alcohol daily. His last binge was 3 days ago. He had multiple episodes of vomitings since day before yesterday, which were present till yesterday initially they were yellowish in colour, large amount then in small amounts. They subsided since yesterday afternoon. Patient went to a goverment hospital for management but sufficient treatment was not given. Patient started  being drowsy since 2pm today and was brought here for    further management.
PAST HISTORY:
He is not a k/c/o DM II, HTN, CVA, CAD, TB, ASTHMA
PERSONAL HISTORY:
Regular alcoholic- whisky 180 to 750ml regularily 4-5 days/week in last 3 years.
Since last 20 days - daily 
Binge of  alcohol (whisky)

GENERAL EXAMINATION:
patient is drowsy, oriented to time, place and person
No pallor
Icterus present
No cyanosis, clubbing, lymphadenopathy, edema

Vitals 
bp-100/70
Pr -119bpm
RR: 24cpm
Spo2 -98% @ RA
GRBS: 203mg/dl
Temp:98.2°F
Rs-bilateral air entry present 
      Nvbs 
CVS -s1 S2 heard
No murmurs 
CNS: NFND, drowsy
P/A:
Soft, non tender
P/A(6/3/23)
Inspection
Abdomen distended
Umblicus slit like
No engorged veins or sinuses or scars
No visible pulsations
No visible mass
Palpation:
No local rise of temperature
No local tenderness 
All quadrants of abdomen are moving equally with respiration
No guarding, rigidity
No palpable mass
Percussion:
Resonant 
Auscultation:
bowel sounds heard
No bruit



INVESTIGATIONS:

USG ABDOMEN ON 27/2/23
2D ECHO ON 28/2/23

ECG 27/2/23
CXR AP VIEW 27/2/23


CXR AP VIEW 1/3/23


CXR AP VIEW 2/3/23
CXR AP VIEW 3/3/23

USG CHEST DONE ON 2/3/23

Diagnostic pleural tap was done on 3/3/23
LIGHTS CRITERIA
effusion protein/serum protein-2.6/5.6-0.46(>0.5)
Effusion LDH/serum LDH 1077/489-2.20-(0.6)
Effusion LDH more than 2/3rd of serum LDH
EXUDATIVE PLEURAL EFFUSION

Ascitic tap was done on 4/3/23


LOW SAAG HIGH PROTEIN
Ascitic fluid cell count
TC:26,900
DC: 70% neutrophils, 30% lymphocytes

USG ABDOMEN ON 5/3/23
USG ABDOMEN REVIEW





Diagnosis - 
MODS with ? DIC secondary to toxin mediated(?alcohol)/ infection(? Bacterial/leptospirosis/viral) with AKI(resolved) with acute liver failure(resolving) with alcohol withdrawal
With thrombocytopenia(resolved)
With right sided pleural effusion
With moderate ascitis(low SAAG high protein)


Treatment:
1. IV FLUIDS 1 unit  NS, RL,  DNS @ 75ML/hr
2. INJ THIAMINE 200MG IV/BD
3.INJ OPTINEURON 1 AMP IN 100ML NS
4..INJ DOXYCYCLINE 100MG IV/BD
5.INJ PIPTAZ 2.25GM IV/TID
6.INJ METROGYL 500MG IV/TID
7.INJ LESURIDE 25MG IV/OD
8.INJ NEOMOL 1GM IV/SOS
9.TAB DOLO 650MG PO/TID
10.TAB OLANZAPINE 2.5 MG PO/HS
11. TAB OXAZEPAM 25MG PO/SOS
12.INJ KCL 40mEq in 500ml NS/IV/STAT



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