32 years old male with c/o yellowish discolouration of eyes since 1 and 1/2 months

 32 year old gentleman who is a GHMC worker by occupation came with the chief complaints of 

 - Yellowish discolouration of eyes since 1 and 1/2 months.

 - SOB since 10 days.

 - Cough since 5 days.

 - Fever since 2 days.

 

History of present illness- The patient was apparently asymptomatic 6 months ago. Then he developed yellowish discolouration of eyes (with a TB- 6 mg/dl). Following which he got scared and stopped consuming alcohol for 3 months. Then his bilirubin levels came down following which he resumed consuming alcohol.

He drank alcohol and fought with his friend and injured his right arm sustaining a fracture to his right arm which was left untreated. His yellowish discolouration of eyes recurred in 1 month hence he stopped consuming alcohol.

H/O GTCS 1 month ago after stopping alcohol for about 10 days- ? Alcohol withdrawal. Patient assumed that his seizures would stop if he resumes consuming alcohol thereby started drinking again. 

1 month ago, his yellowish discolouration of eyes increased so he stopped again. But the discolouration progressed and his entire body turned yellow in 1 month. 

15 days ago, Patient’s attenders burnt his right arm in superstitious belief that his jaundice would come out through the burnt area.

C/O pedal Edema, abdominal distension since 6 days.

C/O productive cough since 5 days

C/O SOB (intermittent) since 5 days.

C/O fever since 2 days- which was low grade.

No h/o cold.

No h/o decreased urine output.


Past h/o: No h/o DM, HTN, TB, BA, Epilepsy, CVA, CAD.


Family h/o: No similar complaints in family 

No h/o DM, HTN, TB, BA, Epilepsy, CVA, CAD.


Personal h/o: 

        Diet- mixed

        Appetite- Normal

        Sleep- Adequate

     Bowel and Bladder movements- Regular

      Regularly consumes 90-180 ml of alcohol since the last 15 years. 

      Occasionally chews tobacco.


General examination:


He is conscious, coherent, cooperative, moderately built and moderately nourished. 


Pallor- Present




Icterus- Present



Cyanosis- Absent

Clubbing- Absent

Lymphadenopathy- Absent

Pedal Edema- Present upto legs



Vitals:


Temperature- 99 F

PR- 110 bpm

BP- 140/90 mm Hg

RR- 20 cpm

SpO2- 100% @ RA

GRBS- 176 mg/dl


Systemic Examination:


P/A: Soft, Non tender, No palpable organomegaly 

Bowel sounds heard. 

Flapping tremors present.





CVS- S1,S2 sounds present. No murmurs

RS- BAE+, NVBS heard

CNS- NAD


Provisional Diagnosis: 

? ACUTE ON CHRONIC LIVER DISEASE 

HEPATIC ENCEPHALOPATHY- GRADE I

HYPOKALEMIA


Investigations: 


Serology- Negative 


Hemogram-



LFT-



RFT-



RBS-



USG Abdomen- 



CXR- PA view



ECG-



ABG-




TREATMENT:


 1. INJ. LASIX 40 mg I.V./BD 

 2. TAB. ALDACTONE 25 mg PO/BD

 3. SYP. LACTULOSE 10 ml P/O H/S

 4. Temperature charting 4th hourly

 5. Tepid sponging SOS

 6. INJ. VIT. K 10 mg slow I.V./OD

 7. SYP. ASCORYL-LS 10 ml PO/BD

 8. SYP. POTCHLOR 10 ml in 1 glass of water PO/BD







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