60/F with AF

 60 yr old female came with

 c/o Fever since one month and 

c/o pain abdomen since 15 days.

c/o Loose stools since 15 days.

Pt was apparently asymptomatic 1 month ago ,then she developed fever since 1 month associated with chills and rigors, intermittent type and evening rise of temp present .

Subsided with medications.

Loose stools since 15 days ,mucoid and watery . Daily 5-6 episodes. Not blood stained and associated with pain abdomen .

H/o Vomitings since 10 days , containing food particles . non projectile .

h/o bloody stiols 40 days ago.

c/o pedal edema since 2 years.

Not a k/c/o htn,dm,cad,asthma.

o/e : 

pt c/c/c.

temp- 100 F

bp- 80/60mmhg

pr- 105 bpm

grbs -101 

spo2- 97% on ra.

HB - 4.8 g/dl

Wbc - 25,300 

RFT : UREA - 126 ; S.creatt - 4.4 mg/dl ; Na -134 meq/l ; k-3.6 meq/l ; cl- 104 meq/l .

ABG : 

PH- 7.29 ,PCO2 - 16.4 ; po2-116 ; hco3- 7.6 

st hco3 - 10.4 

spo2- 97%

Serology - negative .

USG ABDOMEN : 

B/L Grade 2 RPD . b/l kidneys normal size increased echotexture.

MODERATE ASCITIS .

Altered echotexture of liver .(?Cld)

Ivc - 1.2 cm ( max) .

Provisinal Diag - ??AKI ON CKD secondary to Sepsis.

Acute GE .

with A-fib (??Paroxysmal) .

 Treatment given : 

1) IVF - NS/DNS @ urine output plus 50 ml/hr .

2) INJ PIPTAZ 2.25 g/Iv /qid 

3) Inj PAN 40 mg iv od 

4) Inj zofer 4 mg iv tid 

5) Tab sporolac Ds tid 

6) Inj nor ad @ 6 ml/hr 

7) inj amiodarone 150 mg iv stat followed by 10 ml/ hr 

8) Nebulizations with duolin and budecort. 

9) Ors satchets  

10) Vitals monitoring hourly.

 1 prbc transfused for anemia .

Pt was with us for around 12 hours , and was referred later to higher center .