40 year old patient with hepatic encephalopathy
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40 year old male patient , resident of ongole came to causality with chief complaints of :
Generalised weakness , excessive sleepiness and fever since 2 days.
History of presenting illness:
Patient was apparently asymptomatic 10 years back .
Then he started drinking alcohol 90 ml everyday and smoking 1 pack / day
He was admitted to deaddiction centre in our hospital 5 years back for 40 days and then got discharged. He refrained from alcohol for 5-6 months but then started drinking again.
At present he has been drinking 540-720 ml/ day and 2 pack of cigarettes everyday
He came to get admit in deaddiction centre on March 3rd.
2 days back he developed generalised weakness and excessive sleeping, fever.Fever is of low grade , intermittent not associated with chills and rigors.
He had 6-8 episode of seizures in past 10 years inspite of being on medication.
Not a known case of DM, HTN ,CAD ,TB , asthma .
Personal history:
Appetite- Decreased
Diet - Mixed
Bladder movements- yellow coloured urine
Bowel - pale coloured stools
Sleep - increased
Addictions - Alcohol and smoking since 10 years
Family history:
Insignificant
General examination:
Patient is drowsy but arousable.
Icterus - Present
Cyanosis- absent
Clubbing- absent
Lymphadenopathy- absent
Edema- absent
Vitals : temp - febrile
Pulse - 82bpm
BP - 120/80
RR - 18cpm
SYSTEMIC EXAMINATION:
Cvs : s1 s2 +
Rs : BAE +
P/A: soft , non tender
Hepatomegaly +
INVESTIGATION:
CBP -
HB - 11.4
TLC - 7300
platelet count- 1.5 lakh
Smear - Normocytic normochromic
BGT : A + ( positive)
APTT :36 sec
PT : 17 sec
INR: 1.2 sec
RBS : 101 mg/dl
LFT :
Total bilirubin : 6.77
Direct bilirubin: 2.98
SGOT: 157
SGPT: 25
ALP : 507
ALBUMIN 3.1
TOTAL PROTEIN : 6.6
RFT :
Urea -13
creatinine- 0.6
Uric acid - 3.9
calcium- 10.2
Phosphorus- 4.0
potassium - 3.9
Sodium -136
chloride-98
HbsAg - Negative
USG ABDOMEN ( 7/3/22) :
Grade 3 fatty liver with mild hepatomegaly with mild caudate lobe hypertrophy
Mild splenomegaly with early parenchymal licer disease
ECG:
PROVISIONAL DIAGNOSIS:
Decompensated liver disease with alcohol dependence syndrome ( ? Cirrhosis with portal hypertension )
TREATMENT:
Inj. Pantop 40 mg iv /od
Inj thiamine 1 amp il
Inj zofer 4 mg iv / ns
Syrup lactulose 10 ml / po / bd
Tab rifaximin 540 mg / po/ bd
Soap water enema stat
Tab udiliv 300 mg / po / bd
Tab aldactone 25 mg /po /bd
Tab lasix 20 mg /po/ bd
Tab benxl /po/od
Mcotex gums
Tab levittacetam 500 mg /po/bd
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