45 year old male patient,working as security came to the casuality with the chief complaints of fever and yellowish discolouration of eyes and urine since 10 days . 

In 2008 , Patient got admitted in hospital for fever ,he was diagnosed of having jaundice and on medications for 3 months regularly. 

Patient was apparently asymptomatic 10 days back then he developed fever after doing continuous night duties for a week .

Fever ,is continuous ,associated with chills and rigors, relieved on medication( paracetamol,relieves for 1 hour and fever again progresses).

No H/O headache , pedal edema , cough , cold , SOB,burning micturition , chest pain ,melena , night sweats .

H/O mouth ulcers (lower lip) , since 5 days 

had past h/o mouth ulcers , which got relieved by themselves without using any medications .

Not a k/c/o DM,HTN,thyroid ,epilepsy. 

K/c/o alcoholic and tobacco chew since 20yrs.

Patient used to drink alcohol since 20yrs occasionally,but started drinking regularly since 9 yrs ( Drinks whisky 90ml daily ) ,last drink taken 1 week back. 

He used to chew tobacco since 20 yrs daily( 2 packs/day )

He got referred to psychiatry,in view of alcohol dependence.






GENERAL EXAMINATION - 

Patient is c/c/c ,moderately build and nourished .



Pallor : absent



Icterus : present 


No Clubbing , edema , lymphadenopathy.


Due to trauma 

Gait

VITALS 

Temp: 102 

BP: 80/60mmhg

PR: 82bpm 

RR:20cpm 

SPO2: 98% 

GRBS: 136mg/dl 

CVS : s1s2 heard no murmurs 

RESP: Bilateral breath sounds equal .

P/A: soft , non tender 

mild spleenomegaly.

CNS : patient is hypoactive ,

CNS EXAMINATION


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https://youtu.be/F1t3uBSbrRQ


















27/12/20- 










DIAGNOSIS- Fever with anemia secondary to B12 deficiency,with alcohol liver disease with grade 1 hepatic encephalopathy (acc to west haven criteria ) with AKI resolved .


TREATMENT- 
Day 1 
Tab lasix 40mg IV BD 
Tab Rifaximine 150mg POBD 
syrup lactulose 15ml po H/S
temp monitoring and tepid sponging 
salt and fluid restriction 
maintain 2,3 stools / day 
Inj thiamine 1amp in 100 ml NS OD 
tab pcm 500mg PO 

Day 2 
inj pantop IV /SOS
Inj Zofer IV /SOS 
syrup lactulose 15ml po H/S
temp monitoring and tepid sponging 
salt and fluid restriction 
maintain 2,3 stools / day 
Inj thiamine 1amp in 100 ml NS OD 
tab pcm 500mg PO 

Day 3 
Inj lasix 40 mg IV/Bd 
inj monecef 1gm IV/TID 
inj thiamine 1amp in 100ml NS 
Inj Optinueron 1 amp 100ml NS OD 
Inj vit B12 1000mg IM /OD 
syrup lactulose 15ml po H/S
maintain 2,3 stools / day 
Syrup Aristozyme Po/TID 
Salt restriction <2gm/day , fluid restriction <1lt/day 
temp monitoring and tepid sponging 

Day 4 

Inj lasix 40 mg IV/Bd 
inj monecef 1gm IV/TID 
inj thiamine 1amp in 100ml NS 
Inj Optinueron 1 amp 100ml NS OD 
Inj vit B12 1000mg IM /OD 
syrup lactulose 15ml po H/S
maintain 2,3 stools / day 
Syrup Aristozyme Po/TID 
Salt restriction <2gm/day , fluid restriction <1lt/day 
temp monitoring and tepid sponging 
tab .Folvite 5mg PO/OD

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