A 60 yr old female with alcohol dependence syndrome assosiated with viral pyrexia and acallculous cholecystitis

A 60-year-old female patient who is a farmer by occupation and a resident of nakrekal came to the casualty with the cheif complaints of fever since 15 days and shivering, altered sensorium and incoherent talk since 6 day and pain abdomen since 7 days.


HISTORY OF PRESENT ILLNESS :

patient was apparently asymptomatic 15 days back, then she developed fever which was insidious in onset and intermittent in Nature, with chills and rigor 

The patient developed pain in epigastric region 7 days back which was sudden in onset, non progressive and non radiating.

There is history of 1 episode of vomiting, which was non bilious, non foul Smelling, non projectile and food as its contents.

After onset of fever she was taken to a nearby hospital, over there the doctors referred the patient to our hospital and over here she was admitted for 6 to 7 hrs and then got discharged.

On the next day she started having altered sensorium, incoherent talk and tremors so she was rushed to a nearby hospital and again the doctors referred the patient to our hospital.

No history of shortness of breath


PAST HISTORY:

N/K/C/O of DM,HTN,Asthma,TB,Epilepsy,CAD.


PERSONAL HISTORY:

Diet : Mixed 

Appetite : Decreased 

Sleep : Disturbed

Bowel and Bladder moments :Regular 

Addictions:chronic alcoholic since 30yrs 

                   Betelnut chewing since 30yrs

FAMILY HISTORY:

Not significant.


GENERAL PHYSICAL EXAMINATION:

Patient is conscious ,incoherent and cooperative and not well oriented to time, place and person.

moderately built and nourished.

Pallor-absent

Icterus-absent

Cyanosis-absent

Clubbing-absent

Lymphadenopathy-absent

Edema-absent

Vitals:

Temperature - 99.5*c

PR :- 75bpm

RR :-22cpm

BP :- 110/80mm Hg

SPO2 :- 98%

GRBS :-106mg/dl


SYSTEMIC EXAMINATION:
CVS-S1S2 heard no murmurs 

RS-BAE+

CNS-NFND

P/A-soft, tenderness present over epigastric region.


INVESTIGATIONS:

Dengue Elisa -
LFT - on 21 aug
          on 23 aug
CBP -
Blood urea -
ABG -
Serum creatinine - on 21 aug
                                on 23 aug
Serum electrolytes -
Serum amylase -
Lipase -
USG -
ECG -

PROVISIONAL DIAGNOSIS:

Alcohol dependence syndrome associated with Viral pyrexia and Acallculous cholecystitis.

TREATMENT:

IV fluids-NS,RL,DNS

IV monncef 1mg/iv/BD

Inj Rantac 50mg/iv/OD

Inj PMC 2mg/iv/sos if temp is >102*F

Inh Zofer 4mg/iv/sos

Inj Thiamine 200mg in 100ml NS/if/BD

Tab Prednisolone 10mg/po/OD

Tab Olanzepine(mouth dissolving)2.5mg x 2days.

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