PakMediNet Discussion Forum : Medicine : Patient with Fever and Unconciousness
Patient with Fever and Unconciousness
Patient presented with only 2 day history of high grade fever along with drowsiness and unconciousness. He had pulse of 130/min, BP of 130/90, was in Coma grade 3, with Deep jaundice, and tachypnea. He had 4 finger enlarged Hepatomegaly. However, there was no Neck rigidity and Kernig's. After initial resuscitation, NG tube was passed, and on aspiration, found to have mixed blood in it. Inital diagnosis of Fulminant Hepatic Failure, DIC and Septicemia was made. After about 30 minutes, patient started having Opsthitonus, clonic spasms and extensor posturing. Immediately after observing this event, IV injection diazepam was given in a dose of 5 mg. Patient did response. He was in Coma IV at that time. Thinking of cerebral edema, a shot of Mannitol was given. Iv antibotics given were Ceftriaxone 2gm bd, Benzyl Penicillin 40 lac units 4 hourly. Later on, thinking about Cerebral malaria, Quinine Sulphate was also started at the dose of 10mg/kg.
Initial Lab findings were markedly suggestive of DIC and Fulminant Hepatic Failure. ALT was 1395, Bilirubin was 20mg, PT was 90 seconds prolonged and APTT was 50 seconds. Sodium was normal but Potassium was in its lower range of 3.5mEq.
Seeing the detoriating respiration of patient, decision of Mechanical Respiration was made. So, after paralyzing, patient was intubated and put on Ventilator. Mode selected was SIMV and FiO2 of 80% was given.
Patient had repeated epsiodes of clonic spasms (opsithonus) every 10-15 minutes and which got settled with IV valium just for a small while.
Despite aggressive management, patient kept on deterioting and after about 10 hours, died.
What could be the cause of death ?
1. Intracerebral bleed ?
such a short history just of 2 days ?
2. DIC, Septicemia, Acute Fulminant Hepatic Failure
Posted by: docosama Posts: 333 :: 21-07-2001 :: | Reply to this Message
Re: Patient with Fever and UnconciousnessIt is interesting that 27 people have viewed this case & there are no replies/suggestions!There are no answers to such clinical scenarios because there is inadequate lab.support ---what for example did the blood cultures eventually show,blood gases & MP or autopsy findings.There is a long diff.diagnosis--spectulations.We need to with urgency invest in & improve medical care in Pakistan.
Posted by: zhussain Posts: 23 :: 17-11-2001 :: | Reply to this Message
Re: Re: Patient with Fever and Unconciousness
Your critical review tells that nobody dies in Uk.
You are right in a sense that in Pakistan, Health sector needs a lot of investment. But still in present conditions, Pakistan has a very good percentage of talented and competent doctors.
[Edited by docosama on 11-27-2001 at 08:18 AM GMT]
Posted by: docosama Posts: 333 :: 27-11-2001 :: | Reply to this Message
Re: Patient with Fever and Unconciousness
Nowhere in my comments have I even mentioned UK so I dont know where your first sentence came from.
Unless we are critical of ourselves we will never progress.Lets accept in all honesty that a great deal of work needs to be undertaken to improve health care in Pakistan.I have spent quite a number of years practicing medicine in Pakistan at a senior level & am fully aware of medical standards right from affairs of PMDC ,to the medical facilities in govt.hospitals & also how patients are fleeced in private practice.Lets stop kidding ourselves & come to reality world.
Posted by: zhussain Posts: 23 :: 03-12-2001 :: | Reply to this Message
Re: Patient with Fever and UnconciousnessStrong possibility of intra-cerebral bleeding secondry to DIC. CT scan would have revealed it and surgical decompression might have saved his life. Intracerebral bleeding with shifting of brain stem leading to central respiratory failure. Easy for me to say, LOL.
Posted by: chameed Posts: 173 :: 31-03-2002 :: | Reply to this Message