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.
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
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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27 year old female , recently diagnosed with bronchial asthma and 8 months amenorrhea post delivery , presented to ER with sudden onset of grade 4 SOB today morning at 11:00 am with profuse sweating and abdominal discomfort , patient was apparently asymptotic till then Had h/o dry cough since 2 months No h/o vomitings, chest pain , giddiness ,loose stools , decreased urine output ,burning micturition One episode of bleeding per rectum in hospital On arrival Pt -Drowsy,arousable GCS-E3V4M6 Bp-100/60 HR-123/min Grbs-33 Mgdl Chest -Bae , mild wheeze Laboured breathing pattern CVS-s1s2 heard Spo2-98% on room air Cold peripherals with feeble peripheral pulses Advised for CBP,ABG, electrolytes, RFT, urine for ketones, CXR,ECG CBP- HB-13.2,RBC-4.4,wbc-8300,platelet-41000 Electrolytes ,urea & creat in normal range ABG- Ph 6.994,pCO2 10.9, pO2 120.6, HCO3act 2.6 mol/l ,HCO3std 7.2mmol/l UPT is negative Viral markets are negative Couldn’t get Ketones as there is no urine output for patient since morningDr. Surya Teja Rudraraju3 Likes20 Answers
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A 45 yr male presents with vomiting 8 -10 episodes since 3 hrs intermittency, non projectile , reduces on medication, ??features of hypothermia + , no h/o chest complaints , Patient comfortably lying on , Vitals BP 124/70 Pr 82/min S/E NAD ECG attached ,, pls give ur valuable opinionsDr. Jagadish A54 Likes32 Answers