A 60yr old Male came with C/O sob since 4days

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ICU bed 4

A 60yr old Male came  with C/O sob since 4days

HOPI

Patient was asymptotic 20days back, he went to Tirupati and alcohol binge for 15days continuously 

Patient developed SOB (grade 2)on exertion, later progressed to grade 4 and generalized body pains 4 days back.

He had alcohol for 4days now, prior to development of symptoms 

No H/O jaundice, abdominal distension, pedal Edema

No H/O decreased urine output, fever 

Past history 

Not a k/c/o DM, HTN, Asthma, epilepsy

Personal history 

Diet-Mixed 

Appetite-normal

Bowel movements-Regular

Micturition-normal 

He consumes alcohol regularly 

Family history 

Not significant 

General examination 

Pt is drowsy

Vitals 

Temp - 100F

BP-110/70mmHG

Pr-92bpm

RR-32cpm

Spo2-95%

Systemic examination 

Cvs-S1,S2 heard

CNS-Oriented to T/P/P

P/A-Distended, Diffuse tenderness present, guarding present

RS-BAE present, B/L basal crepts present 

Provisional diagnosis 

?MODS secondary to alcohol intoxication 

Acute pancreatitis 

AKI

HFMEF 

Investigations

6/12/21

CBP

Hb-13.3

Plt-20000

WBC-11.09

Serum Amylase-1073

Serum lipase-232

LFT

TB-6.25

DB-2.62

AST- 29

ALT-14

Alk ph-305

TP-6.4

Alb-3.0

RFT

Creatinine-3.3

Urea-117

Sodium-3.3

Potassium-3.8

Chloride-99

Serology-negative 

Dengue-negative

Aptt-36sec

INR-1.33

PT-18

B/G/T- O positive 

ABG

PH-7.1

Pco2-41.6

Po2-61.6

Spo2-87

Hco3-15

ECG

2D ECHO

Chest X-Ray

USG

-Raised echogenicity of bilateral kidney

-Altered echotexture of pancreas

-13*10mm well defined hyperechoic lesion at pole of right kidney

?Focal fat

?focal angiomyolipoma

Treatment 

1)INJ. THIAMINE 100mg in 100ml NS IV/TID

2)INJ.LASIX 40mg IV/OD

3)INJ. PANTOP 40mg IV/OD

4)INJ.ZOFER 4mg IV/SOS

5)GRBS 6th hourly

6)MONITOR VITALS 4th hourly

7)I/O ,temp charting

8)NEB WITH BUDECORT-12th hourly,DUOLIN-6th hourly