A 46 year old male patient with SEVERE METABOLIC ACIDOSIS (RESOLVED) SECONDARY TO ? STARVATION KETO ACIDOSIS ? ALCOHOLIC KETO ACIDOSIS RIGHT HEART FAILURE SECONDARY TO ? WET BERI BERI (RESOLVING)

May 12, 2021

12/05/2021

Intern: Deepthi Thunga

PG- I: Dr. Chandana 

PG-ll:Dr. k.vyshnavi 

Faculty on call : Dr. Hareen

This is an online e log book to discuss our patient de-identified health data 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 evidence based input

This E blog also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome

I\"ve been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history,  clinical findings, investigations and come up with diagnosis and treatment plan.

A 46 yr Old male patient came with C/O SOB SINCE MORNING (10/5/21)

PATIENT WAS APPARENTLY ASYMPTOMATIC TILL A DAY BEFORE (9/5/21) .H/O INSECT BITE OR SNAKE BITE AT FARM @ 8:00 AM ON (9/5/21),BUT ACCORDING TO PATIENT ATTENDERS PATIENT WAS AT HOME ONLY SINCE 9/5/21 MORNING.H/O ALCOHOL BINGE 9/5/21 AFTERNOON,NO INTAKE OF FOOD SINCE 9/5/21 AFTERNOON.C/O SOB SINCE 10/5/21 MORNING ,NO C/O FEVER COLD,COUGH,BURNING MICTURITION.NO C/O CHEST PAIN ,PALPITATIONS,SWEATING.

NOT A K/C/O DM,HTN,CA,CVA,EPILEPSY

O/E: PT C/C/C

BP:110/70MM HG

PR: 82BPM

CVS: S1,S2 +

RS: BAE +

CNS: NAD

On Examination:

Patient was conscious, coherent and cooperative

No signs of cyanosis, clubbing, lymphadenopathy

investigations :

review 2d echo was done on 12/5/21

ultrasound abdomen:

chest x ray :

ECG:

TREATMENT GIVEN:

COURSE IN THE HOSPITAL:

Patient presented with h/o profuse sweating,A/H/O bite by scorpion or snake by patient,but according to patient attendors there is no such thing happened and since 10days patient is at home
History given by patiens son:patient is a chronic alcoholic and he has been consuming alcohol continuously since 2days and did not take any food
3hrs ago patient had profuse sweating and patient became tachypneic for which they brought to our hospital
At presentation patient was tachypneic (RR 40) ,hypotension (SBP 60,fluid bolus given and started on minimal dose of inotropes) ,came up to 110/70 ,spo2 was around 88% and with oxygen 96%,GRBS: 61 MG/DL 25 D was given
2decho was done which showed Right heart failure,D shaped LV   with dilated IVC
In view of rt heart failure,hypotension.hypoxia,D dimers elevated ,ctpa was done to rule out pulmonary thromo embolism,ctpa showed no pulmonary embolism and lung parenchyama was normal.abg showed severe metabolic acidosis with urine for ketones positive ? starvation ketoacidosis ? alcoholic ketoacidosis with wet beri beri .patient was treated with iv fluids 5% dextrose ,thiamine 200mg tid ,next day acidosis was corrected,tachypnoea reduced . review 2 d echo was done which showed dilated right atrium , right ventricular dilatation decreased .there is no D shaped LV.LV contractility normal.patient was advised for further stay in hospital but patient attender want to get discharged at request due to personal reasons .

1.IVF I NS AND I 5D @ 75ML/HR

2.INJ.THIAMINE 1 AMP IN 100ML NS /IV/BD 1-X-1

3.INJ.LASIX 40MG IV/BD

4.INJ.OPTINUERON 1 AMP IN 100ML NS/IV/OD

5.VITALS MONITORING 4TH HOURLY

6.TEMP CHARTING 4TH HOURLY

7.STRICT I/0 CHARTING

8.NICOTEX CHEWING GUMS BD 1-X-