A 42 YR OLD MALE WITH SOB

Case History and Clinical Findings

C/O SOB SINCE 1 WEEK

HOPI- PATIENT WAS APPARENTLY ASYMPTOMATIC 1WEEK, THEN DEVELOPED SOB, GRADE

III-IV, INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE, NO AGGRAVATING AND

RELIEVING FACTORS.

H/O ABDOMINAL DISTENSION SINCE 1ODAYS, INSIDIOUS, PROGRESSIVE, NO

AGGRAVATING/ RELIEVING FACTORS.

NO C/O CHEST PAIN, PALPITATIONS, ORTHOPNEA, PND

NO C/O FEVER, DECREASED URINE OUTPUT, BURNING MICTURITION, VOMITING, LOOSE

STOOLS.

C/O PAIN AND SWELLING OVER THE LEFT LIMB SINCE 10DAYS. INSIDIOUS AND GRADUALLY

PROGRESSIVE, FOLOOWED BY UNKOWN? INSECT BITE.

K/C/O CLD AND ESOPHAGEAL BANDING DONE TWICE (1YR BACK)

K/C/O T2DM SINCE 2016 AND IS ON UNKNOWN MEDICATION.

NOT A K/C/O HTN, THYROID DISORDERS, EPILEPSY.

H/O 3 BLOOD TRANFUSION 4DAYS BACK.

COURSE IN HOSPITAL:

PATEINT CAME WITHC/O SOB SINCE 1 WEEK

SOB, GRADE III-IV, INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE, NO

AGGRAVATING AND RELIEVING FACTORS.

C/O ABDOMINAL DISTENSION SINCE 1ODAYS,

ON ADMISSION VITALS

TEMP- AFEBRILE

BP- 110/70MMHG

PR- 95BPM

RR- 21CPM

CVS- S1S2+, NO MURMURS

RS- BAE+, NVBS

NO ORGANOMEGALY

GRBS- 148MG/DL

ON FURTHER INVESTIGATIONS-

PATIENT WAS FOUND TO HAVE PANCYTOPENIA FOR WHICH 3FFP TRANSFUSIONS WERE

DONE ON 20/08/2023 AND 1 PRBC TRANSFUSION WAS DONE ON 22/8/2023. AND WAS

UNEVENTFULL

GASTROENTEROLOGIST OPINION WAS TAKEN IVO CLD AND H/O ESOPHAGEAL BANDING -

ADVISED TO CONTINUE SAME MEDICATION AS BY TREATING PHYSICIAN.

DIAGNOSTIC AND THERAPEUTIC TAP WAS DONE:ASCITIC TAP WAS DONE ON 20/08/2023

(1LITRE OF FLUID)

ASCITIC FLUID ANALYSIS REVEALED HIGH SAAG LOW PROTEIN 2 TO CLD.

AND ASCITIC TAP WAS DONE ON THE DAY DISCHARGE I.E ON 24/08/2023

AND AFTER TAP VITALS

BP- 110/60MMHG

PR- 86BPM

RR- 19CPM

TEMP- 98.4F

PATIENT WAS MANAGED CONSERVATIVELY AND BEING DISCHARGED IN

HEMODYNAMICALLY STABLE CONDITION.

Investigation

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 19-08-2023 04:14:PM

SODIUM139 mEq/L

145-136 mEq/L

POTASSIUM4.5 mEq/L

5.1-3.5 mEq/L

CHLORIDE102 mEq/L

98-107 mEq/L

CALCIUM IONIZED1.05 mmol/Lmmol/L

LIVER FUNCTION TEST (LFT) 19-08-2023 04:14:PM Total Bilurubin2.58 mg/dl

1-0 mg/dl

Direct Bilurubin0.81 mg/dl

0.2-0.0 mg/dl

SGOT(AST)18 IU/L

35-0 IU/L

SGPT(ALT)11 IU/L

45-0 IU/L

ALKALINE PHOSPHATE253 IU/L

128-53 IU/L

TOTAL PROTEINS6.1 gm/dl

8.3-6.4 gm/dl

ALBUMIN2.10 gm/dl

5.2-3.5 gm/dl

A/G RATIO0.53

COMPLETE URINE EXAMINATION (CUE) 19-08-2023 04:14:PM COLOURPale

yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY

1.010

ALBUMIN

++

SUGAR

NIL

BILE SALTS

Nil

BILE PIGMENTS

Nil

PUS CELLS

2-4

EPITHELIAL CELLS

2-3

RED BLOOD CELLS

Nil

CRYSTALS

Nil

CASTS

Nil

AMORPHOUS DEPOSITS

Absent

OTHERSNil

LIVER FUNCTION TEST (LFT) 22-08-2023 03:52:AM Total Bilurubin1.57 mg/dl

1-0 mg/dl

Direct Bilurubin0.26 mg/dl

0.2-0.0 mg/dl

SGOT(AST)17 IU/L

35-0 IU/L

SGPT(ALT)9 IU/L

45-0 IU/L

ALKALINE PHOSPHATE241 IU/L

128-53 IU/L

TOTAL PROTEINS6.5 gm/dl

8.3-6.4 gm/dl

ALBUMIN2.2 gm/dl

5.2-3.5 gm/dl

A/G RATIO0.53

ASCITIC FLUID ANALYSIS:

NO ACID FAST BACILLI, FEW DISINTEGRATED PUS CELLS, NO ORGANISMS. NO GROWTH

AFTER 48HRS OF AEROBIC INCUBATION.

2D ECHO:

MILD TR +, WITH PAH, TRIVIL AR, NO MR

NO RWMA, NO ASLMS, SCLEROTIC AV, GOOD LV SYSTLOC DYSFUNCTION, NO DIASTOLIC

DYSFUNCTION, NO LV CLOT.

Diagnosis

CHRONIC LIVER DISEASE WITH SPONTANEOUS BACTERIAL PERITONITIS( RESOLVING)

WITH LOWER LIMB CELLULITIS WITH PRE RENAL AKI (RESOLVING) WITH H/O ESOPHAGEAL

BANDING 1YR BACK. (RESOLVING) WITH K/C/O T2DM SINCE 8YRS WITH 3FFP TRANSFUSION

ON 20/08/2023 WITH 1 PRBC TRANSFUSION ON 22/08/2023.

Treatment Given(Enter only Generic Name)

1. FLUID RESTRICTION <1.5 L/DAY

2. SALT RESTRICTION <2G/DAY

3. INJ LINEZOLID 600MG IV/BD

4. INJ PIPTAZ 3.375GM IV/TID

5. TAB SPIRONOLACTONE 25MG PO/OD

6.TAB RIFAGUT 500MG PO/BD

7. TAB LASIX 40MG PO/OD

8. SYP LACTULOSE 15ML PO/BD

9. SYP HEPAMERZ 15ML PO/TID

10. INJ HAI S/C TID PREMEAL

11. TAB UDILIN 300MG PO/OD

12. DRESSING OF LOWER LIMB AND LIMB ELEVATION

13. PROTEIN POWDER 2TBSP IN 1 GLASS OF WATER PO/TID

Advice at Discharge

1. FLUID RESTRICTION <1.5 L/DAY

2. SALT RESTRICTION <2G/DAY

3. TAB LINEZOLID 600MG PO/BD

4. TAB UDILIN 300MG PO/OD

5. TAB SPIRONOLACTONE 25MG PO/OD

6.TAB RIFAGUT 500MG PO/BD

7. TAB LASIX 40MG PO/OD

8. SYP LACTULOSE 15ML PO/BD

9. SYP HEPAMERZ 15ML PO/TID

10. INJ HAI S/C TID PREMEAL

11. TAB AUGMENTIN 625MG PO/TID

12. DRESSING OF LOWER LIMB AND LIMB ELEVATION

13. PROTEIN POWDER 2TBSP IN 1 GLASS OF WATER PO/TID

Follow Up

REVIEW TO MEDICINE OP 78 AFTER 1WEEK OR SOS

When to Obtain Urgent Care

IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR

ATTEND EMERGENCY DEPARTMENT.