40 YEAR OLD WITH GIDDINESS




 40 year old with chief complaints of 

GIDDINESS SINCE 3 DAYS

LOOSE STOOLS SINCE 3 DAYS

YELLOWISH DISCOLOURATION OF SKIN SINCE 2DAYS

HISTORY OF PRESENTING ILLNESS :

Patients was apparently asymptomatic back then he developed blebs on skin of the palm and thigh which was itchy and slowly progressed through out all the body over 2 months  

No treatment was taken for the same

 Lesions are non oozing, initially med which then turned dark and left as pigmented seat on the skin.

later 3 days back patient developed loose stools and vomiting after using herbal medications for the lesions

Patient skipped 3 days taking insulin 


LOOSE STOOLS - water consistency , 20episodes/day , sticky , foul smelling not A/W food intake 

VOMITINGS - whitish food , non projectile , not blood tinged 

YELLOWISH DISCOLOURATION -  eyes and skin since morning with itching

Patient developed ulceration @ Rt foot and had amputation of toe


PAST HISTORY 

 

K/c/o Diabetes since 8 years was started initially on OHA’s and later advised with insulin

Know Alcoholic since 10 years (1 quarter per day)

N/K/C/O HTN , ASTHMA , CAD , CVD , EPILEPSY


PERSONAL HISTORY:

Diet - mixed
Appetite - normal 
Bowel and bladder - loose stools - 20 episodes watery consistency 
Bladder movement were regular
Sleep - adequate
Addictions - Alcoholic since 10 years

FAMILY HISTORY:
No significant family history

GENERAL EXAMINATION 

Patient is Drowsy but arousal

ICTERUS




PALLOR


PAPULES


EXOFOLIATIVE DERMATITIS OF ORAL CAVITY






No cyanosis, clubbing, lymphadenopathy, edema. 

Temp : 100 F
PR: 123 bpm
Bp : 110/80mmhg
RR : 35cpm
Spo2 : 97% 

Apex beat : 5th ICS . 
RS : BAE +, NVBS 
CNS : NAD
FEVER CHART




INVESTIGATIONS 

Chest X - Ray



RED COLOURED URINE 



ECG



On 18/10/22







On 19/10/22







On 20/10/22







PROVISIONAL DIAGNOSIS 

Acute hepatitis with hepatic encephalopathy 2 to toxin induced ? HEAVY METAL POISONING


TREATMENT


IVF - NS/RL @ 75ml/hr 

2.INJ HAI S/C ACCORDING TO GRBS

3.INJ ZOFER 4mg/IV/SOS

4.DAILY APRAXIA CHARTING & SIGNS OF ENCEPHALOPATHY 

5.BP/TEMP/PR/RR/SPO2 - 4th HOURLY

6.GRBS 2nd HOURLY 

7.SYP.LACTULOSE 30ml/PO/TID

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