41y old man with altered sensoriuM

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Here is a case i have seen :



 A 41yr old man  who is a farmer came with complaints of pain abdomen and vomitings since one day


Patient was apparently alright 2 days back later he had pain abdomen following an acute binge of alcohol(750ml of local liquor) in epigastric region, colicky type,non progressive, non radiating,Which got relieved on taking food


He had vomitings-2 episodes, non bilious,non projectile,contents being food particles


No H/o fever, loose stools, melena, abdominal distension, constipation, burning micturition, head trauma


PAST HISTORY:laprotomy done 10 yrs back for peptic ulcer perforation


Not a k/c/o HTN, DM, CAD, epilepsy,CKD


HABITS: He was on mixed diet, normal appetite, bowel n bladder regular


Chronic alocholic since 10-12 yrs-initially 350ml per day later 750ml local liquor every day


Toddy intake 1-2 bottles if liquor not available


Chronic smoker since 10 yrs Beedis—1pack/day


Cravings for alochol and tobacco chewing present


GENERAL EXAMINATION:


Pt is conscious, irritable and confused(GCS-13/15) moderately built and nourished


No Pallor,icterus, cyanosis, clubbing, lymphedenopathy, pedal edema


VITALS: febrile-100 degree celsius


                BP: 160/100mm hg


                Pulse:80bpm


                RR-28cpm


PER ABDOMEN- shape of abdomen-scaphoid 


CVS-s1 s2 heard, no murmurs


RS- BAE clear, no added sounds


CNS- pt is agitated and confused and was restrained 


        Not co operative so could not perform cns examination and MMSE


TREATMENT:


1 NBM till further orders


2 IV fluids


3 INJ PANTOP 40mg OD


4 INJ TRAMADOL 1 amp in 100ml NS BD


5 INJ THIAMINE 1 amp in 100ml NS TID 


6 INJ LOREZEPAM 4mg slow IV /6th hrly




7 INJ HALOPERIDOL 5mg im/sos


8 GRBS 6th hrly


9 BP/temp/PR 4th hrly


10 I/O charting


                    


PROVISIONAL DIAGNOSIS:?ACUTE PANCREATITIS 


                      ?  ALCOHOL    WITHDRAWAL SYNDROME


                                                 ? DELIRIUM TREMENS


                                 ?WERNICKE’S ENCEPHALOPATHY


 umbilicus - inverted , soft, tenderness +, no guarding , no rigidity,no organomegaly, bowel sounds hear


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