ACUTE GI CONDITION CAUSING ALTERED SENSORIUM

CASE SCENARIO 7

CASE REFERENCES - 

- https://sowmyamutyala.blogspot.com/2020/05/hello-everyone.html?m=1

- https://a-blog-by-adityarayilla.blogspot.com/2020/05/medicine-posting-log.html?m=1

65 F, homemaker,  came with the chief complaints of  ALTERED SENSORIUM and

1. Fever - which is insidious in onset, low grade w/o chills and rigor, intermittent type since 2 days  
2. Loose Stools - watery, mucoid, non-blood stained, 10 EPISODES/DAY, w/o pain abdomen since 2 days
3. Vomitings - 1 episode, with food as content, non bilious 
4. Reduced Urine Output - Since 2 days, not associated with burning micturition
5. Facial Edema - Since 1 day

She has a known case of HTN, on medication ; She has Rt sided Hemiparesis with slurred speech owing to a Lt sided parietal lobe infarct since Oct 2019 and is on anti-platelet therapy.

ANALYSIS - 

Acute GI condition, possibly, Food Poisoning, leading to diarrhea, causing DEHYDRATION, leading to hypovolemia, and acute kidney injury/acute exacerbation of chronic kidney condition due to hypovolemia.

Pt might have been in an altered sensorium owing to the electrolyte imbalance due to dehydration followed by kidney injury.

FINDINGS ON PHYSICAL EXAMINATION - 

• Pt was unconscious 
• BP - 50/20 mm of hg
• PR - 67 bpm
• RR - 20cpm
• GRBS - 147 mg/dl - prediabetic ?

- Stabilization of the patient's vitals becomes a priority in such cases.

ANALYSIS - 

 Pt is unconscious with hypotension, bradycardia, tachypnoea ; with a h/o dehydration and kidney dysfunction.

MECHANISM OF THE ABOVE -

DIARRHEA

|

LOSS OF FLUID AND ALKALI [BICARBONATE] FROM THE INTESTINES

|

HYPOVOLEMIA AND ACIDOSIS 

|

DECREASED RENAL BLOOD FLOW AND GRADUAL FAILURE OF COMPENSATORY MECHANISMS

|

PROTEINURIA DUE TO KIDNEY INJURY

|

HYPOVOLEMIC SHOCK PRESENTING WITH ALTERED MENTAL STATUS, HYPOTENSION, BRADYCARDIA AND TACHYPNOEA 

MANAGEMENT - 

• Immediate fluid replacement