42/ M WITH HFPEF WITH ALCOHOLIC DEOENDANCE SYNDROME WITH CHRONIC LIVER DISEASE.
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Here is a case I have seen:
Unit 6:
Case admitted on 27/2/2021.
Interns
Swarna
Juveria
K.Divya
Nikhil reddy
B.Manivarma
Dr. Manasa(pgy1)
Dr. A. Vaishnavi (pgy2)
Dr. Sai Radha(pgy3)
Dr. Arjun (SR)
Dr.Praveen Naik( asst.prof)
Dr.Rakesh Biswas (HOD)
SOB since 2 weeks
Upper limb edema +, pitting type
No facial puffiness.
JVP raising +
No C/O Fever ,Cold, cough
History of present illness :
Patient was apparently asymptomatic 15 days back .Then he C/O Pitting type grade 3
No aggravating and relieving factors
SOB since 15 days( grade 3)
C/o abdominal distension 10 days
C/o scrotal swelling since 1 week
C/o facial puffiness since 3 days
C/o pedal edema of both upperlimbs since 3 days
No c/o nause vomitings diarrhea constipation
No c/o palpitations ,syncopal attacks .
No h/o DM, Epilepsy, Thyroid ,CAD ,Asthma,
Family history
Patient father had-stroke History
Vitals:
PR -90
BP -160/90
RS -BAE +
CVS -S1S2+
CNS- NAD
General examination:
Patient is conscious ,coherent and cooperative
Pallor+
No cyanosis ,clubbing, icteris ,kolilonychia lymphadaenopathy ,edema .
Per abdomem:
Abdomen distended
No tenderness
Provisional diagnosis :
Alcoholic liver disease with hypokalemia
Treatment day 1
1.Inj Lasix 40 mg if sbp>110 mmhg IV BD
2.Fluid restriction <1.5 L day
3.Salt restriction <2 g day
4.Inj. Thiamine 1 ampule in 100 ml NS IV TID
5.Inj. Optineurin 1 Ampule in 100 ml NS IV OD
6.Inj. Pantop 40 mg IV OD
Treatment day 2
1.Fluid restriction <1.5 L day
2.Salt restriction <2 g day
3.Inj. Thiamine 1 ampule in 100 ml NS IV TID
4.Inj. Optineurin 1 Ampule in 100 ml NS IV OD
5.Inj. Pantop 40 mg IV OD
6.T. Lasixlactone 40/100 MG POOD
Treatment day 3
1.Fluid restriction <1.5 L day
2.Salt restriction <2 g day
3.Inj. Thiamine 1 ampule in 100 ml NS IV TID
4.Inj. Optineurin 1 Ampule in 100 ml NS IV OD
5.Inj. Pantop 40 mg IV OD
6.T. Lasixlactone 40/100 MG POOD
Treatment day 4
1.Fluid restriction <1.5 L day
2.Salt restriction <2 g day
3.Inj. Thiamine 1 ampule in 100 ml NS IV TID
4.Inj. Optineurin 1 Ampule in 100 ml NS IV OD
5.Inj. Pantop 40 mg IV OD
6.T. Lasixlactone 40/100 MG POOD
7.Daily weight monitoring
8.HIgh protein diet
9.protein powder 1 tsp in 1 glass of milk twice daily
10.BP ,PR, TEMP ,RR 12 th hrly monitoring
Treatment day 5
1.Fluid restriction <1.5 L day
2.Salt restriction <2 g day
3.Inj. Thiamine 1 ampule in 100 ml NS IV TID
4.Inj. Optineurin 1 Ampule in 100 ml NS IV OD
5.Inj. Pantop 40 mg IV OD
6.T. Lasixlactone 40/100 MG POOD
7.Daily weight monitoring
8.HIgh protein diet
9.protein powder 1 tsp in 1 glass of milk twice daily
10. T. Lorazepam 2 mg PO/OD for 2 days
11.T.LIOFEN XL 20 MG POOD for 2 days
12. T. Prega M 75 mg PO/HS
Treatment day 6
1.Fluid restriction <1.5 L day
2.Salt restriction <2 g day
3.Inj. Pantop 40 mg IV OD
4.T.lasilactone 40/100 mg PO/OD
5.HIgh protein diet
6.protein powder 1 tsp in 1 glass of milk twice daily
7. T. Lorazepam 2 mg PO/OD for 2 days
8.T.LIOFEN XL 20 MG POOD for 2 days
9. T. Prega M 75 mg PO/HS
INVESTIGATIONS
