60 year old female with vomitings ,loose stools and no urine output



60 year old female daily wage labourer by occupation came with the complaints of loose stools and vomiting since 3 days and no urine output since two days .


HOPI: 

Patient is a daily wage labourer since 15 years. Seven days ago she has history of consumption of mutton. Later after 4 days patient came with the complaints of loose stools 5 -6 episodes/ day, watery in consistency,  non mucoid , non bloodstained,non foul smelling since 3 days. 

Complaints of vomitings 4-5 episodes bilious , non projectile,  food as content.

There is also no urine output since 2 days.

No h/o pain abdomen,fever , burning, micturition, cough, cold, Sob



PAST HISTORY : N/k/c/o of Dm, HTN, CAD , TB, BA, Epilepsy. 

No previous hospital admissions. 


Personal history

Appetite- normal

Diet -mixed

 bowel and bladder - increased bowel movements and no urine output

Sleep- disturbed

Addictions- no

No known allergies for food or drugs.


Family history

No similar complaints in the family.

No significant family history.


General examination

Patient is examined in a well lit room with informed consent. 

She is conscious, coherent, co-operative,well oriented to time,place and person.

She is moderately built and moderately nourished.

Pallor - present

Icterus - absent

Cyanosis - absent

Clubbing - absent

Lymphadenopathy - absent

Edema - absent 


Vitals: 


Temp : 98.6 f

PR : 82 bpm 

RR : 24 cpm.

BP : 140/80 mm hg

Spo2 : 97 %@ RA

grbs : 107 mg/dl 


On P/ A examination:


INSPECTION:

Shape – normal

Umbilicus – Central, inverted

Flanks – free

Skin- no sinuses, striae are seen

Dilated veins – absent 

Movements of the abdominal wall with respiration is present 


No visible gastric peristalsis and no visible pulsations. 




PALPATION:


No local rise of temperature 

And tenderness 


All inspectors findings are confirmed.


Deep Palpation- No organomegaly seen 




PERCUSSION:


Percussion of Liver for Liver Span


Percussion of Spleen- Dull note in percussion  


There is no fluid thrill, shifting dullness




AUSCULTATION:



Bowel sounds are heard


CVS : s1 s2 + 

RS : BAE + NVBS

CNS : NAD

 











INVESTIGATIONS : 


HB : 9.2

TLC: 13,100

PCV:28.3

PLT:2.78

N/L/M/E/B: 86/8/2/4/0


UREA: 112

SR.CR: 5.4

Na+:138

K+: 3.3

Cl+: 101


PH : 7.08

Pco2:15.3

Po2: 113

Hco3: 7.1


Interpretation of ABG: high anion gap metabolic acidosis.

USG:




ECG:





DIAGNOSIS : Acute GE with AKI 


TREATMENT : 

1)IVF NS, RL,  DNS @ 150 ml / hr 

2)INJ. MONOCEF 1gm / i.v/ BD

3) INJ. METROGYL 100

ml /i.v/TID

4) inj. LASIX 20 mg i.v BD

5) Syp.potchor 10ml in 1glass water BD

6) Plenty of oral fluids.

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