40 year old male with Gilbert's with wet beri beri cardiomyopathy

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case i have seen:

A 40 year old male farmer by occupation happily married 11 years ago presented to opd with C/O Decreased appetite,bilateral pedal edema,facial puffiness,yellowish discoloration of eyes since 15-20 days 

Tingling sensation of both UL and LL, decreased sleep increased wakefulness +, fever+ every third day since 20 days

Not a/w chills and rigors.

HOPI: Pt was apparently asymptomatic 5 years back then he later (5months)developed bilateral pedal edema which was of pittting type with sob on excertion,palpitations + and was not subsided on using allopathic medication, yellowish discoloration present,facial puffiness was present, fever was on and off since 20 days which was present for 2 days and is off for next half day

 Past history:

Not a k/c/o HTN,DM CAD,TB,ASTHMA 

Personal history:

 He takes mixed diet

appetite normal 

Bowel bladder movements regular

Sleep adequate

Addictions-

regular alchoholic since 15-20 years whisky (90-180ml) weekly twice or thrice

O/e pt is c/c/c 

afebrile to touch 

PR : 82 bpm

Bp: 140/90 mm hg

CVS : s1 s2 +

RS: bae +, nvbs

P/A : soft, non tender, no organomegaly

Grbs: 142 mg/dl

Reports:












Usg abdomen :


2d echo:



Treatment:

Inj lasix 20 mg / iv/bd

Inj pan 40mg/iv/ od

Tab neurobion forte od

Tab pcm 650 po/ sos


Day 2:

No fresh complaints 

O/e pt is c/c/c 

afebrile to touch 

PR : 85bpm

Bp: 130/80 mm hg

CVS : s1 s2 +

RS: bae +, nvbs

P/A : soft, non tender, no organomegaly

Reports:







Treatment:

Inj lasix 20 mg / iv/bd

Inj pan 40mg/iv/ od

Tab neurobion forte od

Tab pcm 650 po/ sos

Inj optineuron 1 amp in 100ml ns/iv/od

Inj thiamine 100mg in 100ml ns/iv/tid


Day 3:

No fresh complaints 

O/e pt is c/c/c 

afebrile to touch 

PR : 85bpm

Bp: 130/80 mm hg

CVS : s1 s2 +

RS: bae +, nvbs

P/A : soft, non tender, no organomegaly

Treatment:

Inj lasix 20 mg / iv/bd

Inj pan 40mg/iv/ od

Tab neurobion forte od

Tab pcm 650 po/ sos

Inj optineuron 1 amp in 100ml ns/iv/od

Inj thiamine 100mg in 100ml ns/iv/tid


Day 4:

No fresh complaints 

O/e pt is c/c/c 

afebrile to touch 

PR : 78bpm

Bp: 110/80 mm hg

CVS : s1 s2 +

RS: bae +, nvbs

P/A : soft, non tender, no organomegaly

Treatment:

Inj lasix 20 mg / iv/bd

Inj pan 40mg/iv/ od

Tab neurobion forte od

Tab pcm 650 po/ sos

Inj optineuron 1 amp in 100ml ns/iv/od

Inj thiamine 100mg in 100ml ns/iv/tid



Treatment at discharge:

Tab neurobion forte od for 30 days

Tab an 40mg od for 30 days

Egg whites/green leafy vegetables 

Tab thiamine 100mg po/od for 15 days

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