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...



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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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.

pls send final dx afer dx

Actually we failed to find the exact dx but we suspected amniotic fluid embolism

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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