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.