e log 2

30 yr male with C/O pain abdomen since 3 days 
Vomiting since 3days 
Fever since 2days 
Decreased urine output since 2 days 
Patient was apparently asymptomatic 3days back then he developed pain in epigastrium and left hemichondrium,colicky type,non radiating ,no aggravating and relieving factors
Associated with vomitings since 3 days 5-6 episodes per day watery immediately after food intake non bilious nonon blood stained
No h/o loose stools
C/O fever since 2 days,high grade intermittent ,not associated wirh with chills and rigor
No h/o cough ,cold,chest pain,sob ,pedal edema
C/O decreased urine output and high coloured urine since 2 days
Patient got admitted in local hospital in view of pain andomen and and vomiting and was referred here in view of decreased urine output 
Not a k/c/o HTN  DM TB asthma CAD 
After 2 days of admission his bp raised to 170 /90 from then he is having intermittent high bp
He is chronic alcoholic since 6 yrs he has binge intake of alcohol 3 days back

No signs of pallor icterus cyanosis clubbing  lympadenopaty  pedal edema 
Temp.101 degree F
Pulse 145 bpm
Bp 120/80 mm Hg
SpO2 99%
RR:18/MIN 
GRBS 128
Per abdomen 
Shape of abdomen   scaphoid 
Tenderness is epigastrium and right hypochondrium
Guarding present
No palpable mass 
Hernial orifices free
No organomegaly 
Bowel sounds +
Serum amylase 319
             Lipase 96.6
Rft
Serum urea 286
             Creatinine 11
Uric acid 13.9
Na+ 130
K+2.7
cl-  96
Lft 
TB 2.63
DB 0.71
Ast 93
Alt 157
Alp 212
Tp 6.5
Albumin 3.8
A/G ratio 1.43

Hemogram 
Hb 11.3
Tc 9100
Platelets 1.30

Esr 20 


LDH 599
CK 127

Treatment given:
1.NBM
2.IVF
3.INJ.PAN40mg/iv /BD
4.INJ MONOCEF 1 gm /iv /BD
5.INJ METROGYL 500 mg/iv /TID
6.I NJ THIAMINE 
7.I/O CHARTING 
8. GRBS 6 th hrly 
Pt shifted for hemodialysis in view of aki
Hemodialysis was done 3 times after which his RFT became normal
2 Days after admission  meropenam was started in view of raised TLC to which pt responded well
Started oral  liquids 3 days after admission 2 days latter started soft diet

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