Chronic Alcoholic

35 year old male who has been having vertigo,loose motions from last few days and now completely avoiding alcohol History His Hb has increased from 5.7 to 6.6 after three doses of Optineuron Inj His HB was low and MCV was very high like 157, so a case of macrocytic anemia Management I had even prescribed redotil 100 bd but no relief in loose motions, kindly help in this matter? His TLC counts are normal too Do u still advise for 2 unit Prbc transfusion for his anemic state or optineuron(B12/folic acid supplementation) will cover it?

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1.For loose motions - Tab Rifaximin 550 mg t.ds for 2 weeks .It will also help to prevent hepatic encephalopathy A pre- prebiotic B.D for 1 month . Inj Iron - sucrose 100 mg alternate days × 5 injections will help correct anaemia,. Give silymarin 140 mg O D for hepato- protection. Don't use UDCA - as it causes diarrhea An upper G.I endoscopy is indicated for esophageal varies and any gastric or duodenal ulcer . Stool for Occult blood USG abdomen for hepatobiliary system to rule out cirrhosis, portal hypertension or Ascitis

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Sir as U r getting response, I would suggest you to continue b12, FA , no BT, if no fever, leucocytosis, pain abdomen , or on any drugs orally , just give ors, and watch, even inj b12 is known to cause diarrhoea, If required can go for stool fats to look for malabsorption and even pernicious anemia can be there, takes sometimes years to manifest, we just assume that alcohol has caused megaloblastic anemia, infact EACH case of anemia should be worked up as per it's cause at least

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PT had developed megablastic anemia .due to Ch alcoholism So cont methycobalmin And folic acid for ,6wks In prompt relief 1,t0unit by T refaxim metrogyl to cont inst anorebic inf and reduce frequency motion Food supliment also to improve Inc metadec to improve PROTIRN storage

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? CHRONIC..ALCOHOLISM.. WITH.. ANEMIA.. LOOSE MOTIONS.. MANAGEMENT.. CONTINUE.. INJECTION..OPTINEURONE AS PER REQUIREMENT.. PROBIOTICS.. SYMPTOMATIC T/T.. ORS.. BT .. INVESTIGATE WITH..SOS.. STOOL EXAMINATION.. ANEMIA PROFILE.. IRON.. CYNOCOBALAMINE.. B12..

Adv Stool R/M/Occult blood. Tab Benalgis 100mg TDS for 3 days f/b 100mg daily for 1 month. Tab Zinconia 50mg OD for 1 month. Glutahenz sachet TDS for 1 week. Cap Imodium 2mg 2 stat, f/b TDS for 3 days. Continue Inj optineuron

3 point blood transfusion Stool rt Anaemia Reticulocyte count Complete haemogram Tibc Ferritin B12

Management of macrocytosis consists of finding and treating the underlying cause. In the case of vitamin B-12 or folate deficiency, treatment may include diet modification and dietary supplements or injections. If the underlying cause is resulting in severe anemia, you might need a blood transfusion.

Of course 2 units of blood transfusion Echonorm 1 bd Naturolax powder in curd two times daily

1)MCV increase- megaloblastic anemia Tab folvit 5mg bd *1 month Tab limce 500 mg bd *15 days Inj vitcofol 2 cc I'm alternate days*5days then 1 a weeks 2cc vitcofol repeat 10 days CBC 2) vertigo with gastroenteritis Tab vertin 16 mg TDs Cap vizylac rich bd Tab rifagut 400 mg TDs Tab roko SOS Tab pan 40 mg od Isabgul powder bd Ors liq qds

Tablet Metronidazole 400mg BD, Second Tablet loperamide... after investigation USG abdominal,LFT,RFT, s.creatinine. I should be suggested to u for multiple vitamins supplements with injection RL,DNS... Neurobion forte ampule OD. Niaciamide with vitamin B,k,E,Thaimine, Coconut fluid... minerals these are supported to degeneration changing and vertigo,internal bleeding. CT scan brain sos.

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