52year old male with Multiple organ dysfunction

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 52year old male toddy tree climber by occupation came with c/o decreased urine output since 2days and anuria since 1day

Grade 4 sob since 1day


Pt was apprently normal 10years ago 

10years ago operated for rt inguinal hernia,pt was fine after the surgery but had on and off pain at the surgical site which aggrevated since 3years so he stopped climbing toddy trees and h/o NSAID abuse for pain since 3years

H/o facial puffiness on and off since 2yeaes

1yr ago pt had h/o SOB grade 2 for which he visited local hospital and was diagnosed to be hypertensive (?unknown medication)


Since 2-3 months on and pedal edema ,urine output was normal at that time

2 days h/o decreased urine output and anuria since today mrng

H/o constipation since 2days

Since 2 days sob grade 2 which progressed to grade 4 today for which he visited local rmp and was referred here

No h/o fever ,cold ,cough,loose stools

No c/o palpitations,giddiness ,sweating


K/c/o HTN since 1 year

Not a k/c/o DM,CAD,CVA,ASthma,TB, epilepsy


Non smoker

Occasional alcoholic


Temp 98

Bp 80/60 after 100ml bolus 90/60

RR 40

Cold peripherals+

Grbs 115

Spo2 98 with 5lit o2

70% without oxygen


Cvs s1s2+,JVP not raised

Rs bae+,

Left ICA ,IMA,IAA wheeze +

Rt ica,iaa wheeze+

Right iaa ISA fine crepst+

P/A soft,NT,Bowel sounds+

CNS GCS 15/15

HMF intact



Hb 14.2

TLC 25,100

Plt 1.8


TB 3.2

DB 1.6

AST 1090

Alt 460

Alp 184


Albumin 3.7


Urea 87

Creat 2.7

Na 139

K 5.2

Cl 105


Serology report awaited


Ecg low voltage complexes with T wave inversions in all chest leads


DIAGNOSIS:

1.MULTIPLE ORGAN DYSFUNCTION syndrome secondary to SEPSIS(AkI ,ALI)


2.Myocardial depression secondary to high AG met acidosis,?acute LVF,?congestive hepatopathy



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