CBBLE UDHC SIMILAR CASES
50 Y old male , labourer by occupation,
Pt came with C/o B/L pedal edema ( Pitting type ) since 1 week.
C/o SOB ( ? grade 1 ) since 1 week
Orthopnea -
C/o 1 episode of PND 2 days back
C/o sleeplessness since 1 week
C/o constipation since yesterday
C/o Anuria since yesterday
Pt went to local hospital used medication for pedal edema and constipation for 5 days but not relieved.
Used amruthanjan oil for pedal edema for 2 days, not relieved ( as told by the attenders ).
HOPI :
Pt had similar complaints of pedal edema 2 years back due to work ( as told by the attenders ) , used medication prescribed by local doctor, relieved on medication .
Pt had 1 episode of vomiting 3 days back , non bilious , associated with food particles .
Appetite reduced since 1 week
Was only on liquid diet and curd rice .
No C/o fever/cough/headache
PAST HISTORY :
N/K/C/O HTN/DM/TB/EPILEPSY/CAD
PERSONAL HISTORY :
Appetite : reduced
Constipation +
Occasional alcoholic - whisky/toddy
Chronic smoker - 1 pack of beedi/day since ? 10 years
O/E : Patient is C/C/C
Pallor +
Icterus -
Cyanosis -
Edema of feet +
Lymphadenopathy -
Clubbing -
VITALS :
Temp : 98.5 F
PR : 72 bpm
BP : 70/50 mmhg
RR : 18
SPO2 : 99 % at RA
SYSTEMIC EXAMINATION :
CARDIOVASCULAR SYSTEM :
S1 and S2 heard, no murmurs heard
RESPIRATORY SYSTEM :
Bilateral air entry present , clear
CNS : NAD
PA : soft, non tender
FAMILY HISTORY: Not significant
PROVISIONAL DIAGNOSIS:
? ACUTE DECOMPENSATED HEART FAILURE CAUSING AKI ON CKD ( PRE RENAL AKI ) WITH CONGESTIVE HEPATOPATHY WITH REFRACTORY METABOILC ACIDOSIS
TREATMENT:
1. Inj. NOR ADR 2 amp in 48 ml NS according to MAP
2. Inj. DOBUTAMINE 1 amp in 48 ml NS acc to MAP
3. Inj. PANTOP 40 MG /IV/OD
4. Inj. ZOFER 4 mg iv sos
5. Inj. PIPTAZ 2.25 gm /iv/bd ( D1 )
6. Inj. THIAMINE 1 amp in 100 ml NS /iv/bd
7. IVF NS, RL @ 50 ml/hr
8. Inj. LASIX 20 mg if SBP > 120 mmhg
9. Fever chart Hourly
10. BP monitor Hourly and GRBS Hourly.
In view of refractory metabolic acidosis and volume over load with anuria patient was planned for dialysis aarogyasree TID taken. But mean while patient became unresponsive and bradycardia ( HR 35) Patient was intubated and put on mechanical ventilation.
Patient became unresponsive and coded , in spite of 6 cycles of CPR performed , patient died .
