A 34 yrs old female 4 hours post lscs came to us with c/o altered sensorium abdominal pain and diffused UGI bleeding. In casualty she was intubated in view of altered sensorium shock and respiratory arrest . then sent to ICU. on investigation she was found to have hb.4 g/dl low plts hight TLC prolong aptt more than 400 INR of 3 severe metabolic acidosis .cr. 3 .. elevated liver enzyme more than 4000 . severe hyperkalemia. Increased d dimer 26000 .Low febrinogen 0.7 . What ll be the ddx? ?? think deep and fresh and make a ddx...

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sepsis and DIC

septicemia multiorgan failure DIC

Yes sir u r right but we didnt find the cause of DIC...We suspected amniotic fluid embolism. ..
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HELLP

DIC has set in, underlying cause may be, amniotic fluid embolism. Metabolic acidosis, hyperkalemia needs trt. Ffp & platelets needs to be infused. Liver injury is probably immunogenic.

Yes sir u r absolutely right we also suspected amniotic fluid embolism.
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pls send final dx afer dx

Actually we failed to find the exact dx but we suspected amniotic fluid embolism
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DIC (low fibrinogen, low clotting factors leading to increased aptt and pt(inr), low platelets, very high d-dimer and clinically UGI bleed, pain abdomen , altered sensorium, shock) Leading to multiorgan failure. The cause of DIC may be HELLP , but cannot confirm hemolysis from this data { Low Hb, acidosis, hyperkalemia can point towards it} History of presentation 4 hours after lscs may point towards amniotic fluid embolism, retained placental bits, or the surgery itself.

Yes sir u r right we also suspected amniotic fluid embolism
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disseminated intravascular coagulation with mods

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