spo2 =78 !!! but asymptomatic???

51 year female ,anganwadi worker, came with cco 

  Epigastic pain :: 3 days 

  Pedal oedema:: 3days

 Epigstric pain associated with sob ::2 days 

H o p i 

Pt. Apparently  asymptomatic  3days back

Then she developed sudden  onsetof epigastric pain without any vomiting or loose stool history, which subsided with medication.

Pedal bl oedem is pitting type extending upto shin since 2 days not associated with any decreased urine output . 

H/o immobilization  present 

No h/o decreased urine output, fever,cough, palpitaions, chestpain ,headache, orthopnea,pnd.

KC of HTN was  on   medication . Bit discontinued  it.

Not a kc of dm,CVA, epilepsy,Asthma.

Surgical history:

Her lower left limb went under Recurent operations. 

She had femur fracture in 2005,implant was placed

 Implant removal done in 2019 and 6days after implant removal she did weight bearing so she again had fracture

 Implant is placed again.

Patient  is a vegetarian by diet, she has loss of APPETITE regular bladder and bowel movements,no allergies and no addiction s

No family h/o DM,HTN ASTHMA,EPILEPSY.

CvA,TB.

Moderately built and moderate nourished 

V i t a l s: 

 Temp:  98F

Pr:  126  bpm

SpO2 :78 % on room Air

Rr : 26cpm

Bp: 110/70

Grbs : 168

SpO2 on 2lt O2 =98%

Dx

?Right heart failure 

secondary 

to cor pulmonale

?HFpEF

?PTE sub massive

 

Kc HTN

Tx

Inj LASIX 40mg BD

Iv fluids Ns  with OPTINEURUM@75ml /hr.

O2 inhalation  @2-4lit/min to maintain spO2 >92%.

T. TELMA 40 mg po OD

Advice: GRBS 6th hry CHARTING .

I N V E S T I G A T I O N  S:

pancreatitis in a chronic alcoholic with AkI

This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent.

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.

31 yr male  farmer by ocupation,resident of Miryalguda Came with cc of
  pain in abdomen since a week
Vomiting since a week
Sob since 2 days.

H  o   p  i 

He was apparently asymptomatic a week ago
came with cc of 
pain abdomen since a week, epigastric region, non radiating ,intermittent type ,relieved by asuming sitting position.
Co vomiting   non projectile,   billious contents of previous meal since a week ;
4-5 eps /day ,lasted for 3 days
Co SOB since 2 days, no ho chestpain, palpitations .
No ho decreased urine output , no  ho pedal oedema. 
Patient was hospitalized a week back and was treated with     Inj . PIPTAZ  Inj . METROGYL ( I.V. F).
  His creatinine increased from 3.8 on 15 /6 to  7.6 on 16 /6 to 17/6  on 8.9 in threedays so was refeted to our hospital.

Not akco DM, HTN,CAD,epilepsy, TB.



P E R S O N A L HISTORY
Apetite normal
Diet : he consumes equal quantiyies of meat and vetarian foods.

b&b normal
Addictions: 
  Hard liquor since 4 years he consumed 180 ml /d.
Last intake was a week back 360 ml.
He chews khaini  since 10 years.

G e n e r a l examination :
No pallor,icterus,cyanosis,clubbing,lymphadenopathy

Pedal edema- present,pitting type

PR-110/min

RR- 26/min

BP-150/100 mmHg

Temp-

SPO2-88%

GRBS-104 mg%

SYSTEMIC EXAMINATION-

CVS-

S1,S2 heard

No thrills and murmurs

RESPIRATORY SYSTEM-

NVBS heard

BAE+, decreased BS on right infra axillary area

ABDOMEN-

Shape-distended

Tenderness-epigastric and hypogastric

 .

CNS-Pt conscious 

Oriented to time ,place ,person .

Gcs - E4V5M6 

Tremors present .

Sensations :       UL       LL  

 Fine                    INTACT     INTACT

Proprioception   INTACT     INTACT 

Vibration             INTACT      INTACT

PROVISIONAL  D I A G N O S I S-

Acute  pancreatitis with AKI 

with ?B/L pleural effusion and moderate ascitis . 

Currently in ?Alcohol withdrawal.

I N VE ST I G A T I O N S : 

 

T R E A T M E N T : 

 Iv fluids : NS 40 ml /hr.

IV lasix  40 mg BD .

Tab Nodosis .

IV PIPTAZ 4.5 Gms. BD 

Iv 25%Dextrose. 100 ml BD 

Tab . Nicardia 10 mg  TID.

D A Y  W I S E  U P D A T E S: 

Day 1and 2 =Urine output 1500ml, 

       Fluid intake 3000ml

DAY 3  :

Scrotal  and penile swelling was obsereved since yesterday, due to which his gait was effected , , for which the fluid input has been reduced .

 

D A Y 4 : 

 Blood and urine cultute given on day 1.

 Ascitic fluid analysis of day 2 :

Investigations done on 24-03 -21

K

CTscan

Urea creat on 26-6-21

28/6/21

 

 

Summary 

Patient came with c/o pain abdomen since 1 week, diagnosed and treated as acute pancreatitis outside for 1 week and was referred to our hospital in view of raising creatinine levels,outside serum amylase was 1450 on 14/6/2021.

Patient was admitted and necessary investigations were sent.Patient was found to have acute pancreatitis with AKI (serum creat 8),B/L mild pleural effusion.As there was no acute indication for dialysis patient was managed conservatively with inj tramadol for pain and IV fluids.Pain abdomen subsided on day 2 of admission.Patient developed pedal edema,scrotal and penile edema on day 4 of admission.Nephrology consultation was taken and adviced for hemodialysis in view of overload features.patient was taken for hemodialysis on day 5 of admission.After 2 sessions of hemodialysis patients serum creatinine came down to 2.7.CECT abdomen was done.