27 year old female , recently diagnosed with bronchial asthma and 8 months amenorrhea post delivery , presented to ER with sudden onset of grade 4 SOB today morning at 11:00 am with profuse sweating and abdominal discomfort , patient was apparently asymptotic till then Had h/o dry cough since 2 months No h/o vomitings, chest pain , giddiness ,loose stools , decreased urine output ,burning micturition One episode of bleeding per rectum in hospital On arrival Pt -Drowsy,arousable GCS-E3V4M6 Bp-100/60 HR-123/min Grbs-33 Mgdl Chest -Bae , mild wheeze Laboured breathing pattern CVS-s1s2 heard Spo2-98% on room air Cold peripherals with feeble peripheral pulses Advised for CBP,ABG, electrolytes, RFT, urine for ketones, CXR,ECG CBP- HB-13.2,RBC-4.4,wbc-8300,platelet-41000 Electrolytes ,urea & creat in normal range ABG- Ph 6.994,pCO2 10.9, pO2 120.6, HCO3act 2.6 mol/l ,HCO3std 7.2mmol/l UPT is negative Viral markets are negative Couldn’t get Ketones as there is no urine output for patient since morning

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Sudden onset SOB Recent Delivery Drowsy with laboured breathing Hypoglycemia at presentation Cold peripherls n feeble pulses Severe Metabolic Acidosis.. Cardiomegaly on Xray ( ?peripatum CMP or Pericardial effusion) Anuria since morning All goes in favour of Severe Sepsis with MODS... Rule out DIC Do PT, aPTT, Fibrinogen CRP/ S Procalcitonin

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ECG SINUS TACHYCARDIA LVH ( STRAIN PATTERN) CXR CARDIOMEGALY METABOLI ACIDOSIS HYPRERVENTILATION RESPIRATORY ALKALOSIS THROMBOCYTOPENIA KNOWN BRONCHIAL ASTHMA CARDIOMYOPATHY . . ACUTE GSTROENTERITIS POSTPARTEM CARDIOMYOPATHY & C H F .

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Ecg. Low voltage S.Tachy Lateral wall ischemia X-ray Cardiomegaly Lab Metabolic Acidosis. Pt might hv Post partam Cardiomyopathy which is Complicated with viral fever which was landed in Septicemia

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Everyone is giving differential diagnosis, but what I expect from u is how can we relate hypoglycaemia with metabolic acidosis that to of sudden onset and thrombocytopenia , patient completely asymptotic one day before the presentation except with dey cough And CBP which was taken 10days back suggestive of platelet count 3.5 lakh Can anyone explain the drastic change in platelet count over this 10days without any clinical symptoms

low platelet count can occur even if the bone marrow makes enough platelets. The body may destroy its own platelets due to autoimmune diseases, certain medicines, infections, surgery, pregnancy, and some conditions that cause too much blood clotting.
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@Thrmobocytopenia hypoglycemia, drowsiness, tachycardia , enlarged cardiac silhouette...unfavourable of Dengue hemorrhagic shock

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Sinus tachycardia

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Look for the lactic acidosis as patient is having abdominal pain,what about anion gap Need to looks if it is metabolic acidosis with high anion gap,or normal anion gap

ECG sinus tachycardia,low voltage in limb leads, x-ray showing cardiomegaly

Seems to be a case of post partum DIC. Should be managed on the line of shock with iv fluid, oxygen inhalation, good antibiotic coverage, cross match blood gp, arrange one unit fresh whole blood

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