35 yr old male with hypoglycemia and altered sensorium secondary to hepatic encephalopathy with k/c/o CLD

Patient brought to casualty with complaints of unresponsiveness since 4 am morning
Yellowish discoloration of sclera and eyes since 6 months
Abdominal distension since 1 week
Pedal edema since 1 week

HOPI : patient was apparently normal till 6 yrs (2014) back then he developed jaundice with altered behaviour went to local hospital and diagnosed with CLD
Patient was chronic alcoholic since 20yrs
In 2014 patient visited hospital with c/o b/l pedal edema, jaundice and abdominal distension and was diagnosed with CLD
Since then patient was on irregular medication and continued taking alcohol intermittently
Since 4 days, patient has c/o fever subsided now used 4 tablets of DOLO
C/o loose stools 4-5 episodes per day,no h/o malena , pain abdomen
C/o nausea and loss of appetite
C/o altered sensorium since today morning not responding to commands
No h/o weakness and no h/o involuntary movements

PAST HISTORY: 
    N/K/C/O HTN/DM/ASTHMA/CAD
      K/C/O PULMONARY KOCHS 15 YRS BACK USED ATT

General examination :

Pt is conscious,coherent and cooperative.thin built and malnourished.

No pallor
No icterus
No clubbing
No lymphadenopathy
No edema
 
Vitals :

Temp : Afebrile
BP : 100/80 mm Hg
PR : 105 bpm
RR : 25 cpm
GRBS : 33 mg / dl
SpO2 : 91 % @ RA

Systemic Examination :
CVS : S1S2 + , No murmurs
RS : BAE + , NVBS +
P/A : Soft , Nontender , BS +
CNS : Response to pain

Provisional diagnosis : 

HEPATIC ENCEPHALOPATHY SECONDARY TO LIVER FAILURE
RECURRENT HYPOGLYCEMIA
K/C/O CHRONIC LIVER DISEASE WITH GROSS ASCITES AND SPLENOMEGALY(PORTAL HTN)-PRECIPITATED BY PCM USAGE
GRADE 2 OESOPHAGEAL VARICES

Clinical images :

PLAN OF TREATMENT:
INJ.LASIX 20 MG/IV/BD
TAB.ALDACTONE 50 MG/RT/BD
INJ.25% DEXTROSE 100ML/IV/SOS IF GRBS<60 MG/DL
SYP. LACTULOSE 20 ML/PO/BD
INJ. THIAMINE 1 AMP IN 100 ML NS/IV/TID
GRBS CHECK HOURLY
BP/PR/TEMP CHARTING HOURLY
T. UDILIV 300 MG/ RT/BD
SYP. HEPAMERZ 2 TBSP/RT/BD
T RIFAXIMIN 550 MG /RT/BD
ENEMA 12 TH HOURLY
STRICT I/O CHARTING
INJ.CEFOTAXIME 2G /IV/BD

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