I feel it’s opium induced or over dose Your tratment Nalaxone is perfect It’s respiratory depression and shock Above drug helps in both Fluid support
Drug induced Respiratory Depression And Shock. Needs further investigation and evaluation to conclude and line of treatment.
...SUGGESTIVE. OF INDUCED.. RESPIRATORY DEPRESSION
Dx-opium poisoining. Symptoms-1-drowsy. 2-nausea. 3-hypothermia. 4-respiratory depression. All are suggestive of opium poisoining.but inadequately treated by naloxone. So treat further with naloxone 400microgm iv every 10 minute interval . IV fluid. Inj ondesterone 1amp iv sos.till respiratory rate drowsyness nausea becomes normal.size of the pupil is main feature to stop naloxone.pinpoint pupil must be dilated and reacting to light.
Still effect of opiod or naloxone effect?
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￼ Symptoms Of Addison's Disease Addison’s disease, where your adrenal glands don’t function properly, can cause low levels of the hormones aldosterone and cortisol. Early symptoms include fatigue, lethargy, muscle weakness, poor mood, dehydration, frequent urination, a hankering for salty foods, and loss of appetite and weight. Later, symptoms like dizziness, vomiting, diarrhea, cramps, hyperpigmentation, low libido, missed periods, delayed puberty, and abdominal, joint, and back pain kick in. Your adrenal glands may be tiny but they produce two important hormones – aldosterone and cortisol. Cortisol helps control metabolism and blood sugar while aldosterone controls potassium and sodium levels in your blood. When you have Addison’s disease, your adrenal glands don’t function properly. As a result, you may have low levels of these hormones, affecting your body’s capacity to respond effectively to physical stress. In most cases – around 70% or more – Addison’s disease is caused by an issue in the immune system. It attacks the outer layer of your adrenal gland and disrupts the normal production of hormones. However, Addison’s disease may also be caused by damage to your adrenal glands through an infection like tuberculosis, cancer, genetic defect in the adrenal glands, or other diseases. Let’s take a look at some symptoms that can alert you to the presence of this disease. Symptoms experienced during Addison’s disease can vary from person to person. It is also easy to miss this disease in the initial stage because the signs can be similar to other more common conditions like flu or even depression. Some **early signs include: 1. Fatigue Fatigue is characterized by an intense need for rest. When you feel fatigued you may be so low in energy that doing anything can seem difficult. Fatigue is a normal response to prolonged stress, physical exertion, and lack of sleep. But if you are not able to trace it to a specific cause, it is a cause for concern and needs to be checked out. 2. Lethargy Lethargy or feeling abnormally drowsy or tired is another symptom of Addison’s disease. Changes in the sodium levels in your blood, because of aldosterone imbalance, can lead to drowsiness. This is also an often neglected sign, especially when it’s the only prominent sign. But if you have been feeling overwhelmed by a sense of lassitude, it’s time to probe deeper. 3. Muscle Weakness Muscle weakness is the loss of strength in your muscles. That is, you find it difficult to move your muscle in spite of trying hard. Even simple, mundane things like getting up from a chair, brushing your hair, or lifting something becomes tough. 4. Dehydration Dehydration can be an early indicator of Addison’s disease. It is caused by low levels of aldosterone which plays a role in regulating the water and salt balance in your body. Some early signs of dehydration include thirst, strong smelling and dark-colored urine, a dry mouth, and tiredness. 5. Low Mood Feeling low, mildly depressed, or irritable can be an early symptom of Addison’s disease. 6. Appetite Loss If you have Addison’s disease, you may experience a loss of appetite as well as lose weight without intending to do so. 7. Frequent Urination A need to frequently urinate is also associated with this condition. 8. Hankering For Salt A reduction in aldosterone can cause low levels of sodium. Your body tries to compensate for this by consuming salt and that’s why a craving for salty foods. While these symptoms tend to crop up early, other later symptoms of Addison’s disease develop slowly over months or even years. But there isn’t really a clear demarcation in how the symptoms appear. For instance, extra stress, as is caused by an accident or another illness, can aggravate the condition and result in symptoms suddenly becoming worse. 9. Dizziness Dizziness is another symptom that people with Addison’s disease experience. When you have low levels of aldosterone, you lose too much sodium. This can cause a drop in blood volume, which in turn lowers your blood pressure. And low blood pressure can cause symptoms like dizziness and even fainting, especially when you stand up. 10. Gastrointestinal Problems Gastrointestinal problems like nausea and vomiting can also be signs of Addison’s disease. High levels of potassium may be leaving you nauseated. Some people also face diarrhea. 11. Pain Abdominal pain, back pain, and joint pain are all symptoms that tend to show up later. 12. Muscle Cramps As Addison’s disease progresses, you may experience muscle cramps. A cramp is a brief, sudden, and involuntary contraction of a muscle that causes you pain. 13. Persistent Exhaustion Addison’s disease can cause you to feel chronically exhausted. This may sometimes lead to depression in certain people. 14. Hyperpigmentation Of Skin In people with Addison’s disease, the pituitary gland releases extra corticotropin to try to trigger the adrenal glands. Since corticotropin also triggers the production of melanin, the pigment which gives skin color, you may experience hyperpigmentation of skin if you have this condition. Your lips, gums, the creases in the palms of your hands, knees, knuckles, or the area around your nipples may develop a dark discoloration. You may also notice black freckles over your face, forehead, and shoulders. 15. Low Libido Another sign of this disease is a reduced sex drive or loss of interest in sex. This symptom tends to show up especially among women. 16. Missed Periods Certain women with Addison’s disease may also get irregular periods or skip their period entirely on some months. 17. Low Blood Sugar Addison’s disease can increase your body’s sensitivity to insulin, which may lead to low levels of blood sugar. This can result in symptoms like confusion, trouble concentrating, anxiety, and loss of consciousness. 18. Delayed Development In Children A child’s body starts to change and develop during puberty. The age at which this happens can vary from 8 to 14, though the average age at which puberty begins is 11 for girls and 12 for boys. However, puberty may be delayed and occur much later than is normal in children who suffer from Addison’s disease. 19. Signs Of Adrenal Crisis If you don’t treat Addison’s disease, levels of hormones in your body slowly decrease, causing your symptoms to become progressively worse. This ultimately leads to what is known as an adrenal crisis – which can potentially be fatal. When you have an adrenal crisis, your symptoms can come on quickly and be extremely severe. These may show up alongside symptoms of Addison’s disease. But there is also the chance of these severe signs kicking in even when you’ve not experienced any other symptoms before. Here’s what you need to look out for: Severe Dehydration Signs of severe dehydration include extreme thirst, feeling abnormally confused or lethargic, and a rapid heartbeat. You may also experience dizziness when you stand up which doesn’t pass after a few seconds. Changes To Your Skin Your skin may feel clammy, pale, and cold. You may also sweat excessively. Changes To Your Breathing Your breathing may become shallow and rapid. Worsening Symptoms You may experience a severe form of the symptoms typically experienced in Addison’s disease. That is, you may suffer from: Severe diarrhea and vomitingSevere muscle weaknessSevere drowsiness, even a loss of consciousnessSevere and sudden pain in the abdomen, lower back, or legs Headache A headache is another sign which may indicate an adrenal crisis when seen in conjunction with the other symptoms described above. An adrenal crisis should be treated as a medical emergency. If immediate medical assistance is not provided it can result in a coma and even death. A delay in treatment can also result in permanent disability as your brain may be deprived of sufficient oxygen. What Can You Do About Addison’s Disease? Addison’s disease is typically treated with medicines that augment low levels of hormones. And you’ll usually need to be on medication throughout your life if you have this condition. But the good news is that the symptoms of this condition can be controlled with treatment and you can lead a normal life without many restrictions. Do take the precaution of carrying a card specifying that you have Addison’s disease – in case of an emergency healthcare workers can treat youDr. Tapan Kumar Sau1 Like5 Answers
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80 yrs old male,brought by relatives, in drowsy state, h/o chest pain and vomiting since last evening. BP 70 systolic. spo2 80%. CVS pan systolic murmer+ RS bil crepts heard ECG attached. patient is taken on invasive ventilation. Hb 8, sr creat 3.2, urea 80, BSL 86, trop T positive.Dr. Sandeep Ghodekar7 Likes41 Answers
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45 yr old male k/co htn presented to ed with h/o sob right leg swelling . decreased urine output, BP -60/40 PR 130 spo2 78 ,on roomair RR 22 WBC 19800 cr 4.9 urea 138 d dimer 0.9Dr. Mahesh Mareddy6 Likes15 Answers
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According to the World Health Organization , waterborne diseases account for an estimated 3.6% of the total DALY (disability- adjusted life year) global burden of disease , and cause about 1.5 million human deaths annually. The World Health Organization estimates that 58% of that burden, or 842,000 deaths per year, is attributable to a lack of safe drinking water supply, sanitation and hygiene (summarized as WASH ).  Overview The term waterborne disease is reserved largely for infections that predominantly are transmitted through contact with or consumption of infected water. Trivially, many infections may be transmitted by microbes or parasites that accidentally, possibly as a result of exceptional circumstances, have entered the water, but the fact that there might be an occasional freak infection need not mean that it is useful to categorise the resulting disease as "waterborne". Nor is it common practice to refer to diseases such as malaria as "waterborne" just because mosquitoes have aquatic phases in their life cycles, or because treating the water they inhabit happens to be an effective strategy in control of the mosquitoes that are the vectors . Microorganisms causing diseases that characteristically are waterborne prominently include protozoa and bacteria , many of which are intestinal parasites , or invade the tissues or circulatory system through walls of the digestive tract. Various other waterborne diseases are caused by viruses . (In spite of philosophical difficulties associated with defining viruses as " organisms ", it is practical and convenient to regard them as microorganisms in this connection.) Yet other important classes of water- borne diseases are caused by metazoan parasites. Typical examples include certain Nematoda , that is to say "roundworms". As an example of water-borne Nematode infections, one important waterborne nematodal disease is Dracunculiasis . It is acquired by swallowing water in which certain copepoda occur that act as vectors for the Nematoda. Anyone swallowing a copepod that happens to be infected with Nematode larvae in the genus Dracunculus , becomes liable to infection. The larvae cause guinea worm disease .  Another class of waterbornemetazoan pathogens are certain members of the Schistosomatidae , a family of blood flukes . They usually infect victims that make skin contact with the water.  Blood flukes are pathogens that cause Schistosomiasis of various forms, more or less seriously affecting hundreds of millions of people worldwide.  Long before modern studies had established the germ theory of disease , or any advanced understanding of the nature of water as a vehicle for transmitting disease, traditional beliefs had cautioned against the consumption of water, rather favouring processed beverages such as beer , wine and tea . For example, in the camel caravans that crossed Central Asia along the Silk Road , the explorer Owen Lattimore noted, "The reason we drank so much tea was because of the bad water. Water alone, unboiled, is never drunk. There is a superstition that it causes blisters on the feet."  Socioeconomic impact Waterborne diseases can have a significant impact on the economy, locally as well as internationally. People who are infected by a waterborne disease are usually confronted with related costs and not seldom with a huge financial burden. This is especially the case in less developed countries. The financial losses are mostly caused by e.g. costs for medical treatment and medication, costs for transport, special food, and by the loss of manpower. Many families must even sell their land to pay for treatment in a proper hospital. On average, a family spends about 10% of the monthly households income per person infected.  Infections by type of pathogen Protozoan Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Amoebiasis (hand-to-mouth) Protozoan ( Entamoeba histolytica ) (Cyst-like appearance) Sewage , non- treated drinking water , flies in water supply, saliva transfer (if the other person has the disease) Abdominal discomfort, fatigue , weight loss, diarrhea , bloating , fever Cryptosporidiosis (oral) Protozoan ( Cryptosporidium parvum ) Collects on water filters and membranes that cannot be disinfected , animal manure , seasonalrunoff of water. Flu-like symptoms , watery diarrhea, loss of appetite, substantial loss of weight, bloating , increased gas, nausea Cyclosporiasis Protozoan parasite ( Cyclospora cayetanensis ) Sewage , non- treated drinking water cramps , nausea, vomiting , muscle aches, fever, and fatigue Giardiasis (fecal- oral) (hand-to- mouth) Protozoan ( Giardia lamblia ) Most common intestinal parasite Untreated water, poor disinfection, pipe breaks, leaks, groundwater contamination, campgrounds where humans and wildlife use same source of water. Beavers and muskrats createponds that act as reservoirsfor Giardia. Diarrhea, abdominal discomfort, bloating , and flatulence Microsporidiosis Protozoan phylum ( Microsporidia ), but closely related to fungi Encephalitozoon intestinalis has been detected in groundwater , the origin of drinking water  Diarrhea and wasting in immunocompromised individuals. Bacterial Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Botulism Clostridium botulinum Bacteria can enter an open wound from contaminated water sources. Can enter the gastrointestinal tract through consumption of contaminated drinking water or (more commonly) food Dry mouth, blurred and/or double vision , difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea . Death is usually caused by respiratory failure . Campylobacteriosis Most commonly caused by Campylobacter jejuni Drinking water contaminated with feces Produces dysentery like symptoms along with a high fever . Usually lasts 2–10 days. Cholera Spread by the bacterium Vibrio cholerae Drinking water contaminated with the bacterium In severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhea, nausea , cramps , nosebleed , rapid pulse , vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 12–18 hours. E. coli Infection Certain strains of Escherichia coli (commonly E. coli ) Water contaminated with the bacteria Mostly diarrhea. Can cause death in immunocompromised individuals, the very young, and the elderly due to dehydration from prolonged illness. M. marinum infection Mycobacterium marinum Naturally occurs in water, most cases from exposure in swimming poolsor more frequently aquariums ; rare infection since it mostly infects immunocompromised individuals Symptoms include lesions typically located on the elbows, knees, and feet (from swimming pools ) or lesions on the hands ( aquariums ). Lesions may be painless or painful. Dysentery Caused by a number of species in the genera Shigella and Salmonella with the most common being Shigella dysenteriae Water contaminated with the bacterium Frequent passage of feces with blood and/ or mucus and in some cases vomiting of blood. Legionellosis(two distinct forms: Legionnaires' disease and Pontiac fever) Caused by bacteria belonging to genus Legionella (90% of cases caused by Legionella pneumophila ) Legionella is a very common organism that reproduces to high numbers in warm water;  but only causes severe disease when aerosolized.  Pontiac fever produces milder symptoms resembling acute influenza without pneumonia . Legionnaires' disease has severe symptoms such as fever , chills , pneumonia (with cough that sometimes produces sputum ), ataxia , anorexia , muscle aches, malaiseand occasionally diarrhea and vomiting Leptospirosis Caused by bacterium of genus Leptospira Water contaminated by the animal urine carrying the bacteria Begins with flu-like symptoms then resolves. The second phase then occurs involving meningitis , liver damage (causes jaundice ), and renal failure Otitis Externa (swimmer's ear) Caused by a number of bacterial and fungal species. Swimming in water contaminated by the responsible pathogens Ear canal swells, causing pain and tenderness to the touch Salmonellosis Caused by many bacteria of genus Salmonella Drinking water contaminated with the bacteria. More common as a food borne illness . Symptoms include diarrhea , fever , vomiting, and abdominal cramps Typhoid fever Salmonella typhi Ingestion of water contaminated with feces of an infected person Characterized by sustained fever up to 40 °C (104 °F), profusesweating ; diarrhea may occur. Symptoms progress to delirium , and the spleen and liver enlarge if untreated. In this case it can last up to four weeks and cause death. Some people with typhoid fever develop a rash called "rose spots", small red spots on the abdomen and chest. Vibrio Illness Vibrio vulnificus , Vibrio alginolyticus , and Vibrio parahaemolyticus Can enter wounds from contaminated water. Also acquired by drinking contaminated water or eating undercooked oysters . Symptoms include abdominal tenderness, agitation, bloody stools, chills, confusion, difficulty paying attention (attention deficit), delirium, fluctuating mood, hallucination, nosebleeds, severe fatigue, slow, sluggish, lethargic feeling, weakness.  Viral Disease and Transmission Viral Agent Sources of Agent in Water Supply General Symptoms SARS(Severe Acute Respiratory Syndrome) Coronavirus Manifests itself in improperly treated water Symptoms include fever , myalgia , lethargy , gastrointestinal symptoms , cough , and sore throat Hepatitis A Hepatitis A virus (HAV) Can manifest itself in water (and food) Symptoms are only acute (no chronic stage to the virus) and include Fatigue , fever, abdominal pain, nausea, diarrhea, weight loss, itching, jaundice and depression . Poliomyelitis (Polio) Poliovirus Enters water through the feces of infected individuals 90-95% of patients show no symptoms, 4-8% have minor symptoms (comparatively) with delirium , headache , fever , and occasional seizures , and spastic paralysis , 1% have symptoms of non- paralytic aseptic meningitis . The rest have serious symptoms resulting in paralysisor death Polyomavirus infection Two of Polyomavirus : JC virus and BK virus Very widespread, can manifest itself in water, ~80% of the population has antibodies to Polyomavirus BK virus produces a mild respiratory infection and can infect the kidneys of immunosuppressed transplantpatients. JC virus infects the respiratory system , kidneys or can cause progressive multifocal leukoencephalopathy in the brain (which is fatal).  Algal Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Desmodesmus infection desmodesmusDr. Tapan Kumar Sau10 Likes16 Answers
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A 48yrs old male presented to ED having H/o sudden onset LOC and seizure with multiple episode of vomitting.K/c/o HTN not on regular treatment as advice by his family doctor.O/e CNS - conscious,alert,oriented,Right UMN facial palsy,Both pupils are normal in size.GCS-E3V4M4,Bp-170/90mmhg.Diagnosis?Dr. Prashant Ved8 Likes41 Answers