A CASE OF ACUTE PANCREATITIS

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A 60 year old male,farmer by occupation from naglonda came to casualty with complaints of pain abdomen since 5 days and decreased urine output since 1 day. 

Patient works as a farmer and is an alcoholic since 20 years with 90ml whiskey everyday with apparently asymptomatic 5 days ago then he developed pain abdomen after intake of 180ml of  alcohol which is diffuse more in the epigastric region, which reduced on bending forward

He was admitted yesterday at a local hospital for his pain abdomen. 

He was referred to our hospital in view of  decreased urine output since morning 

No c/o fever, vomitings,pedal edema,facial puffiness,SOB,cough, burning micturition. 

Not a k/c/o DM,HTN,CAD,CVA, Epilepsy

On examination patient is conscious, coherent, cooperative 

Pallor+

No icterus, cyanosis, clubbing, lymphadenopathy, edema 

Vitals: 

Temp-98 degrees F 

PR-86 Bpm 

RR-18 Cpm 

BP-60/40 mm Hg on admission 

Spo2:98% at room air 

GRBS-87 Mg% 

Per abdomen -

Diffuse tenderness+ 

Guarding+

Bowel sounds + 

RS: 

Bilateral Inspiratory crepts in infrascapular region 

CVS:S1S2+ 

CNS:NFD

Diagnosis -

Acute Pancreatitis

With Acute kidney injury 

INVESTIGATIONS: 

Hemogram: 

Hb-9.1 

Tlc-8,000 

PCV-27.1 

MCV-89.4 

MCH-30.0 

RBC COUNT-3.03 

Ptc-2.31 

Normocytic normochromic anemia 

Sr Amylase-509 

Sr Lipase-84 

LFT: 

T.bil-0.79 

D.bil-0.15 

AST-48 

ALT-54 

ALP-321 

T.protein-4.9 

Albumin-2.8 

A/G-1.34 

RFT: 

Urea-23 

Creatinine-1.8 

Ca-9.0 

Phosphorus-2.9 

Na-141 

K-3.7 

Cl-108 

TREATMENT: 

1)NBM TILL FURTHER ORDERS 

2)IVF 2 PINTS BOLUS F/B NS,RL,DNS @100 ML/HR 

3)INJ.TRAMADOL 1 AMP IN 100 ML NS IV/TID 

4)INJ.PAN 40 MG IV/OD 

5)INJ.ZOFER 4 MG IV/TID 

6)INJ.THIAMINE 200 MG IN 100 ML NS IV/BD 

7) HOURLY BP MONITORING,PLAN TO START INOTROPES IF REFRACTORY HTN 

8)PR/SPO2/TEMP MONITORING 

9)GRBS 12TH HOURLY