Wednesday, September 5, 2007

Hepatic Encephalopathy with Hepatic Failure and Hepatorenal Syndrome

A boy of 2 years and 3 months presented with deep jaundice, in semiconscious condition and with bleeding per rectum.

When asked mother said that he developed jaundice I month back from which he gradually recovered. Then he was given antihelmenthic 3 days back after which his condition deteriorates
On examination, he was found to be deeply jaundiced with oedema and ascites.
On admission pulse was 126/m, BP 90/60 mmHg, temperature 102.5, respiratory rate 50/m, liver was not palpable.

On investigation, his Hb was 11.5 gm/dl(on admission), TLC-15200/cmm, N-78%, L-12%, bilirubin 28.8 mg/dl, direct 12.7, indirect-16.1, SALT 342 U/L , Alkaline phosphatase 487U/L , HBsAg negative, Prothrombin time 60 sec with control 22 sec, ratio 4.28, Index 23.3%, INR 5.56 Serum Albumin 3.4gm/dl. Random blood sugar 42.8 mg/dl, Serum creatinine .6 mg/dl, serum electrolytes-normal.

Patient was progressively deteriorating, develops convusions and anuria

Patient is labeled as Hepatic Encephalopathy with Hepatic failure and Hepatorenal Syndrome

The patient is kept on parental fluid, oxygen, antibiotics, lactoluse, konakion, pulv streptomycin, Inj Mannitol and blood , domamine etc.

The patient is fighting for his life.

[Note: When the liver in hepatitis patient regresses in size, it indicates grave sign and poor prognosis
Recovery from hepatorenal syndrome is also difficult
When Hepatic Encephalopathy is grade IV, mortality is also high]

Badrud Doza

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