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40 Y/M with weakness and SOB

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 CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT.    

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


I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan 

6-08-2022

A 40 year old male came to OPD with chief complaints of  weakness and shortness of breath since 10 days

HOPI

Patient was apparently asymptomatic 10 days back then he started having weakness and shortness of breath which was invidious in onset and accelerated on consumption of alcohol 

He is taking alcohol since 10 days after abstaining for 3 years 

Attender reported that he is consuming 24 - 26 units of alcohol since past 10 days 

When he doesn't consume alcohol he is having trembling and giddiness and having cravings for alcohol recently 

H/o smoking in the form of chewing since 10 days initially 1 pack per 2 days currently 1 pack per day and now he denies any cravings for tobacco


Past history 

He was admitted in hospital a week ago ? Alcoholic delusions and then they given some medication which the patient did not take

No h/o head injury , seizures , hallucinations 


Personal history 

Takes mixed diet 

appetite normal  

Sleep adequate

Bowel and bladder regular

Addictions : a chronic alcoholic stopped drinking alcohol 2 years back and now he is continuing to take since 10 days

Consumes tobacco in form of chewing 


General physical examination 


Pt was conscious coherent cooperative moderately built and nourished well oriented to time place and person 

Pallor Icterus cyanosis clubbing lymphadenopathy edema absent


Vitals

 temperature : 98.6°F 

PR : 80 bpm

BP : 110/70

RR : 19 CPM


Systemic examination 

CARDIOVASCULAR SYSTEM - S1 and S2 present, No murmurs

RESPIRATORY SYSTEM - BAE +, NVBS

PER ABDOMEN - Soft and Non tender, Scaphoid shaped abdomen ,

                               No free fluid , 

                              No palpable mass, 

                              No organomegaly . 


CENTRAL NERVOUS SYSTEM - No focal neurological deficits


Investigations


USG 


Urine examination 


ECG 



Provisional diagnosis

Alcohol dependence syndrome with grade 3 fatty liver

Treatment

Inj. Thiamine 200 mg in 100ml NS i/v BD

Inj. Zofer 4 mg i/v TID

Inj. Pantop 40mg i/v OD 

Inj.Optineurin in 500 ml NS i/v OD

Tab. Lorazepam 2 mg  PO/BD

Moniter Vitals.
 












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