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Posted In: I cannot get a diagnosis. 2 Replies
  • Posted By: dr.satish kumar
  • September 7, 2010
  • 04:56 AM

19 yr old presenting with sudden onset breathlessness 4 hours after consuming unknown food, developed swelling of lips n tongue , seen in ER, was intubated n mechanically ventillated, hemodialysed, recoverd well ,discharged home after 10 days of stay in the hospital.....whats the clinical diagnosis.

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2 Replies:

  • possible peanut allergy. He needs to be tested for food allergies--msg, food dye, shell fish.
    Monsterlove 2,921 Replies
    • September 7, 2010
    • 05:51 AM
    • 0
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  • 1. Demographic profile (include age, sex and occupation) 19 year old female working in a textile (knitting) industry Unmarried2. Place of residence (country, part of country) Working in the textile industry situated in Coimbatore but nativity is Nagapattinam, Tamilnadu INDIA3. History in detail (including medical, marital, sexual and personal history) She was normal until 7:00am on 17/12/2009 when she had her breakfast in the hostel later on she developed breathlessness at around 11:30am. Clinical examination revealed the following:Primary Survey:• A (Airway) Compromised due to swollen lips & tongue• B (Breathing) Dyspnoeic with RR of 18/minute, Sao2 96% in room air• C (Circulation) Heart rate: 132/min, BP 150/100 mmHg• D (GCS) - 12/15 Systemic Examination:• CVS: NAD• RS: Bilateral air entry equal, crepitations +++• ED management: Airway secured by Emergency Tracheostomy and connected to the ventilator4. Biochemical investigations  ABG on the day of admission: pH 7.336, pCO2 29.6mmHg,pO2 164.6 (FiO2 35%),HCO3- 16.4,lactate 3.9mmol/L Urea 29mg/dl, Creatinine 1.02mg/dl,Na+137mEq/L,K+ 2.67mEq/L,Cl-106mEq/L,HCO3-14mEq/L,LFT Biluribin WNL, SGPT 428U/L, SGOT 802U/L, ALP 126U/L, GGT40U/L5. Hematological investigations WMC TC 23800/microL, Hb: 15.6, platelet 305000/microL, ESR 05mm Urine R/E: reaction: 6.0, albumin; 2+, RBC 5-6cells/HPF Urine R/E (day2 of Hospitalization) Colour Brown,Cloudy,Albumin 3+,Sugar 1+,RBC 5-7 cells/HPF,WBC 1-2cells/HPF,Hb,Mb is positive but cannot differentiate with between Hb/Mb, uric acid ++++,amorphous phosphate ++++6. Radiological investigations (include pictures of CXR or CT/MRI if possible) CXR Normal, CT brain Normal study7. Clinical course in short and treatment given with outcomeDay 1: Patient was SIMV mode, vitals stable.Day 2: Pupils 3mm (+), both eyes (+)Decerebrating to painful stimuliHypoxic encephalopathyDark colored urine since morning?Plan: Haemodialysis Day 3: Hemodialysis done Patient conscious, responding to call, obeys commands, vitals stable Day 4: Patient conscious, oriented, obeys commands, vitals stableDay 5: Patient conscious, oriented, obeys commands, vitals stableDay 6: Patient conscious, oriented, obeys commands, vitals stable.Planned for oral food. Dialysis catheter removed. Transferred to IMCU.Day 7: Patient was transferred to ward, started on oral liquids Later she became drowsy, not obeying commands. Pulse, BP not recordable. Patient shifted to ICU. Tracheostomy tube was found to be blocked, CPR started, Inj. Dopamine infusion started. Patient prognosis explained to relatives.Day 8: Patient unconscious, decereberate posture. Ventilator support CPAP mode.Day 9: Patient unconscious, decerebrate posture. Ventilator support CPAP mode.Day 10: Patient unconscious, decerebrate posture. Ventilator support CPAP mode.Day 11: Patient unconscious, decerebrate posture. Ventilator support CPAP mode.Day 12: Patient conscious, responding to painful stimuli. Weaned from ventilator.Day 13: Patient conscious, responding to painful stimuli. Weaned from ventilator. Vitals stable. Day 14: Shifted to IMCU. Mid night patient was desaturating, connected to ventilator on SIMV mode.Day 15: Patient unconscious on ventilator. CPR started, resuscitation continued as per ACLS algorithm. Could not be revived. Declared dead at 05:20pm on 13-Dec-2009.Cause of death: Brain death. Hypoxic encephalopathy. Ischemic hepatitis.
    Anonymous 42,789 Replies
    • September 7, 2010
    • 03:50 PM
    • 0
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