A chronic Alcoholic with Altered Sensorium
A male aged 54 years who was chronic Alcoholic Chief Complaints Altered Sensorium (x 2 days) Irrelevant Talks Personality changes Physical Examination P/A- Distended, Free fluid(+) GCS - E4V4M6 Confusion(+)
Chronic Alcoholic C/o Alcoholic liver disease with decompensation presenting with hepatic encephalopathy ....... Necessary inv to be done to rule out possible precipitants : Infections GI Bleed Dyselectrolytemia Dehydration Hypoxia Constipation Renal decompensation Treat with Tab Rifaximin 550mg BD Inj Hepamerz Syp Lactulose 25ml BD Duphalac enema if required Cefotaxime to prevent SBP Maintain nutrition, avoid protein excess Further treatment modification according to lab reports......
CLD/Hepatoencephelopathy/ Peritoneal Ascites, DO CBC & ESR, LET, Serum Protein with Electrolytes, Urine RM, RBS, USG W/A, Plan Peritoneal ascites or free fluid taping and send for R/M, Start Tab. Rifagut 200 mg, Tab. NUSAM, Tab. Dytor 10 mfor od, tab. Udiliv 150 mget, Tab. Rehaptin 400mg , Tab. Ciplar 10 mg - od, Tab folvite 5 mg, tab. Pre & pro biotic DOR CXR P/A, ENG, FUTHER TREATMENT AFTER PATHOLOGICAL REPORT
Seems to be in hepatorenal failure Hepatic tremors + Altered sensorium is fallout of uremia Distended abdomen with free fluid suggest ASCITIS due to renal insufficiency Needs to workout
Flapping tremors Hepatic encephalopathy Liq. Lactulose 2tsp bd Tab. Stalopam plus sos tab. liv 52 ds 1 bd
PT.CHRONIC ALCOHOL HEPATIC ENCEPHALOPATHY? CBC? LFT?
Give him injection lorazepam 2ml iv bd and high dose of vitamins
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