35yr old female with loose stools

 This is online E-blog, to discuss our patient de-identified 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 the patients clinical problem with current best evidence based input.

This E-blog also reflects my patient's centred online learning portfolio.

I have 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 a diagnosis and treatment plan.

PATIENT WAS UNRESPONSIVE AT THE TIME OF PRESENTATION ( HISTORY GIVEN BY ATTENDER (BROTHER) )

PATIENT HAD C/O LOOSE STOOLS AND VOMITINGS SINCE 15 DAYS

A/W H/O FEVER 1 EPISODE WHICH SUBSIDED AFTER TAKING PARACETAMOL C/O GENERALISED WEAKNESS SINCE 1 WEEK ( PT CCOULDNOT EVEN WALK) NOT A K/C/O DM,HTN,THYROID,ASTHMA,BLOOD TRANSFUSIONS, EPILEPSY 

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC 4 YAERS BACK THENSHE DEVELOPED PAIN ABDOMEN AND BLOATING FOR WHICH SHE WAS DIAGNOSED WITH ANTRAL GASTRITIS AND WAS KEPT IN HOSPITAL AFTER COLONOSCOPY. PATIENT WAS UNDER REGULAR MEDICATON

8 MONTHS BACK PATIENT HAD C/O JOINT PAINS ( POLYARTHRALGIA) FOR WHICH SHE WAS GIVEN TREATMENT

PATIENT THEN HAD H/O FEVER , LOOSE STOOLS AND VOMITINGS 15 DAYS BACK FOR WHICH SHE WAS TREATED AT PRIVATE HOSPITAL , FEVER SUBSIDED AND NO IMPROVEMENT IN LOOSE STOOLS , VOMITINGS.

AT PVT HOSPITAL ON 10-05-2022, INVESTIGATIONS WERE DONE S/O RAISED RFT ( CREAT : 2.1MG/DL) AND UREA 121 MG/DL

, RAISED LFT ( SGPT: 190 IU/L, SGOT: 390 IU/L, ALP : 2200 IU/L) , HYPOALBUMINEMIA : 2.08 MG/DL, PRO BNP: 19041 PG/ML, TROPO I POSITIVE, 2D ECHO : EF 37%, USG: GRADE 2 FATTY LIVER, B/L RENAL G-1 PARENCHYMAL CHANGES, SPLENOMEGALY, TREATED WITH O2, IV ANTIBIOTICS, ANTACIDS, DIURETICS, PROBIOTICS AND OTHER SUPPORTIVE MEDICATIONS. PATIENT ATTENDERS LEFT AGAINST MEDICAL ADVICE OF THE HOSPITAL AND THEN CAME TO KIMS NARKETPALY.

GENERAL EXAMINATION :

NO PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMPHADENOPATHY, OEDEMA TEMP - 98.6 F

BP: 80/60 MMHG

PR - 88 BPM

SPO2 - 98 AT 10LIT O2

GRBS - 150 MG/DL

CVS - S1 S2 HEARD

RS - BAE PRESENT, B/L BASAL CREPTS +

P/A - SOFT , NT

CNS - E2V1M2

DEATH SUMMARY:

35 YEAR FEMALE ADMITTED AT OUTSIDE HOSPITAL INITIALLY WITH C/O PAIN EPIGASTRIUM ON AND OFF SINCE 3 TO 4 DAYS AMD WITH SOB ON EXERTION SINCE 3 TO 4 DAYS , C/O LOOSE STOOLS AND VOMITINGS SINCE 15 DAYS WITH GENERALISED WEAKNESS , FEVER ON AND OFF SINCE 5 DAYS. DIAGNOSED WITH CAD , MOD. LV DYSFUNCTION EF 37 %,? STRESS CARDIOMYOPATHY , CARDIOGENIC SHOCK OUTSIDE HOSPITAL, WAS TREATED WITH INOTROPES , OXYGEN SUPPORT , ANTIPLATELETS, ANTICOAGULANTS AT OUTSIDE HOSPITAL. OUTSIDE CREAT: 2.1, UREA: 129, TROP I: 190 IU/L +, PROBNP 19041 PG/ML, 2D ECHO : EF: 37 % , LATERAL WALL HYPOKNIESIA , ECG S/O ACUTE ANTEROLATERAL MI, S.AMYLASE: 460.

PATIENT CAME LAMA FROM OUTSIDE HOSPITAL . AT PRESENTATIONBP: 60/40 MMHG, PR: 80 BPM, TEMP: 98 F, GRBS: 150 MG/DL, SPO2 : 96% AT 4 LIT O2 , STARTED ON DUAL INOTROPES , ANTICOAGULANTS, ANTIPLATELETS, ANTACIDS, ANTIEMETICS. BP WAS MONITORED CONSTANTLY, IT WAS NOT IMPROVING WITH DUAL INOTROPES . TRIPLE INOTROPES SUPPORT WAS STARTED AND TITRATED ACCORDING TO MAP . PATIENT WAS INTUBATED AND CONNECTED TO MV AT 2.30 PM I/V/O LOW GCS (3/15). 5 CYCLES OF CPR GIVEN , PT COULD NOT BE REVIVED AND DECLARED DEAD ON 11/05/2022 AT 4.10 AM

IMMEDIATE CAUSE OF DEATH: REFRACTORY HYPOTENSION SECONDARY TO CARDIOGENIC SHOCK HFREF ( EF 37% )

ANTECEDENT CAUSE OF DEATH : HFREF SECONDARY TO CAD ( ANTEROSEPTAL MI ), CARDIOGENIC SHOCK , AKI, H/O ACUTE GE ( ? ACUTE PANCREATITIS)

ASSOCIATED CONDITION : K/C/O ? SERONEGATIVE RA, H/O CENTRAL GASTRITIS

1) INJ.NORDRENALINE 2AMP + 100ML NS @ 10ML/HR 2) INJ.DOBUTAMINE 1AMP + 50ML NS @ 3.6 ML/HR

3) STRICT I/O CHARTING

4) INJ.LASIX 20MG IV BD ( IF SBP >100MMHG)

5) TAB.ECOSPIRIN 150 PO H/S 6)FLUID RESTRICTION <1.5 L/DAY

8) SALT RESTRICTION <1.5 G/DAY

9) BP, PR, SPO2 CHARTING HOURLY 10) O2 INHALATION 8LIT/MIN

11) INJ.PAN 40 MG/IV/OD

12) INJ.ZOFER 4MG/IV/TID 13)INJ.HEPARIN 5000 IU IV QID 14)TAB.CLOPITAB 75MG PO H/S 15)TAB.ATORVAS 40MG/PO/ H/S

16) INJ.VASOPRESSIN 1 AMP + 45 ML NS @O.1ML/HR 17)NEB.ASTHALIN 2 RESPULES STAT