42YR MAN WITH ALCOHOL DEPENDANCE SYNDROME

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case that I have seen:

GM unit 3 admission on 24/2/21

Interns:
Dr Harsha
Dr Kalyan
Dr Jeeharika
Dr Sreeja
Dr Archana

Dr Raveen PGY1
Dr Aashita Kashyap PGY2
Dr Aravind PGY3
Dr Vamshi PGY3

Dr Hareen SR
Dr Praveen Naik Ass.Prof
Dr Rakesh Biswas HOD

42yr old man presented to casualty with
Irrelevant talk since morning
Giddiness since morning
Epigastric pain since morning

42yr man who is a farmer by occupation at local village. He is married and has a son. Since past 20 years he has been consuming around 90ml/day of whiskey daily, slowly he increased the consumption to 720ml/day(one full bottle) since the last 10years.

Patient has been repeatedly being getting admitted with irrelevant talk and giddiness. Last time he got admitted one week back and got diagnosed with Alcoholic Liver Disease with Alcohol Dependence Syndrome. He presented to casualty back then with similar complaints and he had hypoglycemia  with a GRBS-20mg/dl. 

His last intake of alcohol was 180ml 1hr back.


O/E:
Patient is confused with irrelevant talk.

Temp-98F
PR-86bpm
BP-90/60 mmHg
RR-18cpm
SPO2-98%
GRBS-111mg/dl

CVS- S1 S2+
R/S- BAE+
P/A- tenderness on Epigastric region, Bowel sounds+

Investigations:
Psychiatry referral was taken I/V/O Alcohol withdrawal:

Hemogram on 26/2/21


Diagnosis: Alcoholic liver disease with Alcohol Dependence Syndrome.

Treatment:
1.IVF 2units NS and 1unit RL @ 100ml/hr/IV
2.Inj.THIAMINE 1Amp in 100ml NS IV TID
3.Inj.PANTOP 40mg IV OD
4.Inj .ZOFER 4mg IV SOS
5.Inj.TRAMADOL 1Amp in 100ml NS IV SOS
6.Tab.LORAZEPAM 2mg PO
1-1-1-2
7.Tab.BACFEN XL 20mg PO OD
8.Monitor vitals
9.Strict I/O charting


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