49 year Male with Pain Abdomen

July 13, 2022

This is an online E logbook 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 a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs.

Presenting complaints :

C/O Constipation since 3 days ;

C/O Pain Abdomen since 2 days ;

C/O Multiple episodes of vomiting since a day ;

C/O Decreased Urine output since a day ;

C/O SOB since today morning .

HOPI :

The patient had history of binge Alcohol drinking since 4 days with no intake of food . He had history of Constipation since 3 days. History of burning type of generalized abdominal pain since 2 days . History of vomiting 20-30 episodes since a day, non projectile, non bilious, alcohol as a content and decreased urinary output since a day which was progressed to nil urine output since night on 07/07/2022.

PAST HISTORY :

HTN since 3 years on TAB. METAPROLOL 25mg once a day at 8 AM.

PERSONAL HISTORY :

Sleep decreased .

Appetite decreased .

Bowel : constipation .

Bladder : decreased urinary output which progressed to nil urine output .

Addictions :

1. Alcohol consumption since 30 years ; initially in the form of toddy gradually shifted to whisky , the frequency and quantity of alcohol intake also increased . Increased consumption of alcohol since 4 years .

2. Tobacco consumption in the form of gutkha since 10 years , 2 packs per day .

FAMILY HISTORY :

History of alcoholism and tobacco consumption in the family members .

GENERAL EXAMINATION :

Patient was conscious , coherent and cooperative.

Moderately built and nourished .

PR : 70 bpm ; RR : 32cpm ; SpO2 : 98%@RA ; GRBS : 54 mg/dl .

CVS : S1 ,S2+ , No murmurs ; R/S : BAE+ , Clear ;P/A : Soft , diffuse Tenderness + , Bowel sounds are sluggish ; CNS : NAD.

COURSE IN THE HOSPITAL :

49 year male brought to the casuality i/v/o above mentioned complaints . Upon arrival, patients RR:32cpm; BP: 90/60mmHg; PR: 70bpm and GRBS: 54mg/dl; The patient was in severe dehydration. He was started on 1 unit of 25%D , noradrenaline infusion 5 ml/hr and 2 units of NS. ABG was taken which showed metabolic acidosis with bicarbonate of 1.1 ; 100 meq of sodium bicarbonate correction was started .

ECG on the day of admission :

General surgery cross consultation was taken I/v/o diffuse abdominal pain and tenderness and orders followed .

USG Abdomen was done which showed bowel gas has obscuring the view .

CECT Abdomen was advised by the duty surgery pg ,for which Nephrology opinion was taken i/v/o Serum creatinine 1.7 and Blood urea 36 and for CECT Abdomen , they have given High risk for contrast study .

CT Abdomen was done which showed Diffuse Fatty liver .

Serum Amylase 111 , Serum Lipase 48 and TLC 23,400 . The patient was kept on NBM , fluid challenge along with loop diuretic and IV antibiotic was started ; Urine for ketones were negative ; Ryles tube and foley's insertion was done on 08/07/2022 . Samples for blood for ketone bodies has been sent.

ECG on 08/07/2022 at 11pm.

Urine for culture and sensitivity

NBM was continued on day 2 of admission, he was on continuous fluid therapy, his RFT has deranged. On examination abdominal tenderness has subsided, patient passed stools. Bowel sounds are normal.

Ryle's tube has been removed on day 3 of admission. He was slowly started on oral fluids followed by soft diet. Ambulation was done. Blood for ketones were positive.

Foleys has been removed on day 4 of admission. Complained of craving for alcohol; abnormal behaviour for which psychiatry cross consultation was done.