Case 12 - A case of shock, metabolic acidosis and acute gastroenteritis in a 55 year old female patient

A case of shock, metabolic acidosis and acute gastroenteritis in a 55 year old female patient.


Hi, I am R. Ramya Keerthana, 5th semester medical student. This is an online elog book to discuss our patients health data after taking their consent. This also reflects my patient centered online learning portfolio.

Case Scenario
A 55 year old woman from Mallepally came to casualty on 7th of June with chief complaints of:
- pain in right side of the abdomen since 2 days
- SOB since 1 day
- vomiting since 2 days
- loose stools since 2 days
- fever since 2 days
- reduced urine output since 1 day

History of Presenting Illness
- patient was apparently asymptomatic 2 days ago when she developed right flank pain which was sudden in onset, gradually progressive, continuous, non- radiating, and of squeezing type. No aggravating factors and not relieved on medication.
- 2 days ago she also had diarrhea, 3-4 episodes on 1st day and 10 episodes on the next day. Stools are watery and foul smelling with no trace of blood.
- she had 5-6 episodes of vomiting 2 days ago and 8 episodes the next day which did not subside on medication. The 1st episode had food contents and the following were watery, non-projectile, non-bilious and foul smelling. She had no travel history or consumption of outside food.
- h/o SOB Grade 4 since 1 day. She has been experiencing Grade 1 SOB since 10 years.
- h/o fever since 2 days. Fever is insidious, continuous, high grade and relieved on medication.
- h/o reduced urine output since 1 day.
- no h/o rashes, constipation, melena, bleeding, hematemesis and burning micturition.

Past History
- k/c/o thyroid disorder since 3 years on regular medication 
- k/c/o HTN and DM since 5 months on regular medication. She was diagnosed after having left pedal edema for 1 month 
- n/k/c/o tuberculosis, CAD, epilepsy, asthma
- no h/o surgeries 
- no h/o blood transfusions.

Personal History
- married
- manual labourer by occupation 
- mixed diet
- reduced appetite since 3 days 
- inadequate sleep since 3 days 
- increased bowels since 2 days 
- reduce urine output since 1 day 
- no known allergies
- no addictions

Family History
- h/o HTN and DM 
- no diabetes mellitus
- no cancers
- no heart disease 
- no stroke
- no tuberculosis 
- no asthma
- no other hereditary diseases

Drug History
General Examination
- patient was conscious, coherent and cooperative 
- well oriented to time and space
- well built and adequately nourished
- no pallor
- no icterus
- no cyanosis 
- no clubbing of fingers
- no lymphadenopathy 
- no pedal edema 
- no malnutrition 
- no dehydration 

Vitals
07/06/23
- BP: 90/60 mm Hg
- Pulse rate: 150 bpm
- Respiratory rate: 27 cpm
- Temperature: 100°F
- SPO2: 97% at RA
- GRBS: 120 mg/dL


Fluid Intake and Urine Output
07/06/23
Total Input: 1500 ml
Total Output: 500 ml


Fever Chart


Systemic Examination
Cardiovascular System
- no thrills
- cardiac sounds S1 and S2 heard
- no cardiac murmurs

Respiratory System
- no dyspnea
- no wheeze
- trachea position: central
- breath sounds: vesicular
- no adventitious sounds

Abdomen
- shape: obese
- no scars, striae, engorged veins
- tenderness present 
- bowel sounds heard
- no bruits, rubs
- no shifting of dullness
- no fluid thrill
- no palpable mass
- hernia orifices: normal 
- liver: not palpable 
- spleen : palpable

Central Nervous System


Investigations
Treatment 



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