Case 6

 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input



 A 40 year old male patient came to the casualty with chief complaint of Shortness of Breath worsening since 2 hours Grade 3-4
Palpitations +
B/L pedal edema + , pitting type since 10-15days
Abdominal distension and 
Decreased urine output since 15days
H/O fever 1 week back, it's subsided now 

Patient was apparently asymptomatic 6 months ago 
He then developed an episode of Sob to which he visited a local doctor and he was relieved of his symptoms and he was diagnosed to have  (? LIVER FAILURE ) with yellowish discoloration of eyes and was adviced medication
He had intermittent episodes of Sob and continued medication 

H/O pedal edema  in both lower limbs since 10-15days insidious in onset, progressively worsening and attained to present size
H/o of abdominal distention since 1 month which progressively increasing
Endoscopy was done Grade 1 varices were present
Ultrasound was showing  mild splenomegaly
H/o decreased urine output since 10-15days , Normal stream, post voidal residue with urgency and hesitancy

K/C/ O diabetes mellitus since 6 months - On medication
Not a K/c/o Htn,asthma,Tb,epilepsy,Cad

Personal history:
History of intake of toddy since 16 yrs of age
Whiskey and brandy 90-180ml since 10-12 yrs

H/O ascitic tap done in Miriyalguda 1 week back
H/o of dialysis ( one) i/v/o renal failure 
Creatinine on 8/10/21 was 6.3 mg/dl
On 9/10/21 -3.9 mg/dl

No significant family history

On examination

Pt is C/c/c
 Vitals 
Bp - 90/80mm Hg
PR - 78 bpm
Rr - 16 cpm
SpO2 - 98%
Temperature 98.1 F
CVS - S1 S2 heard
RS - BAE +
Per Abdomen -  Shifting Dullness
Bowel sounds- sluggish


Provisional Diagnosis - Chronic Liver disease,
Hepatorenal syndrome, CKD

 
 Treatment:-

1.Fluid restriction < 1 L / day
2. Salt restriction < 2gm / day
3. Tab.  Aldactone 50mg/PO/BD
4.Syp. Lactulose 15ml/BD
5.Tab. Thiamine 100mg/PO/OD 
6. Tab. Rifagut 550mg/PO/BD
7.Abdominal girth & weight monitoring
8. Tab. Udiliv / PO/OD
9.Protein Powder with 100ml milk 

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