A 65 yr old male a F/U/C of Cholangio CA (Post Op) and T2DM presented with watery loose motions , confusion and irrelevant behavior, Fever (on/off) and Abdominal Distension since 2-3 days...Was found to be in Altered Sensorium and confusion....What is the clinical approach?


Here Differentials could be Metabolic encephalopathy Sepsis induced delirium Underlying cirrhosis related HE Uremic encephalopathy Keep NPO, start IV fluids, give Lactulose enema, IV hepamerz... Cover with broad spectrum...

Thnkyou Sir...we have started with the same approach

Encephalopathy.... Septic first likely, metabolic, Hepatic, any other medical issues related. Any obvious source of sepsis to be looked out like RTI,UTI,SBP,etc. Ascites fluid analysis...tc,dc,c/s

Sir there is no sign of sepsis...No fever, tachycardia leukocytosis or leukopenia nothing...The patient has been found to be HbsAg reactive and the HBV DNA count is being sent

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What about sodium and POTASSIUM.urine ketones

rule out small bowel obstruction acute pancreatitis ABG,electrolytes

Electrolytes imbalances

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