A case of AGE with peripheral circulatory failure.pptx
1. A CASE OF ACUTE GASTROENTERITIS WITH
PERIPHERAL CIRCULATORY FAILURE AND
ACUTE KIDNEY INJURY REQURING RENAL
REPLACEMENT THERAPY.
Dr. Suraj Adhikari(PG Medicine)
Dr. Parvati Nandy(Professor and HOD Medicine)
2. A 68 years old male ,Mr X a known diabetic and
hypertensive under medication from Kannur disctrict
in Kerala reached Gangtok via Chennai and Kolkata in
the evening of 25th of February where he had dinner in
a local hotel where he was lodging. After three to four
hours he developed sudden onset abdominal cramps
followed by multiple episodes of watery stool, for
which he attended the ER of CRH.
Watery stool was associated with nausea but no
vomiting.There was no history of fever, pain
abdomen,antibiotic use,tenesmus,no blood in stool,No
history of similar complaints from fellow travellers.
He was having 2-3 loose stool every 10 minutes.
3. His urine output decreased over the next few hours
and he gradually became drowsy overnight . His urine
output ,blood pressure and consciousness level was
strictly monitored hourly along with appropriate
medications and required investigations.In less than 5
hours he developed acute renal failure with severe
metabolic acidosis and shock.With timely
interventions with inotropes and 3 cycles of
hemodialysis over the next two days he regained
normalcy and we could dicharge him on the sixth day
of his admission.
4. DIFFERENTIAL DIAGNOSIS:
1)Bacterial food poisoning
Staphylococcus aureus Intense vomiting and watery diarrhoea 1-4
hours after ingestion
Bacillus cereus Vomiting after 1-6 hours and diarrhoea after
8-16 hours of ingestion
Clostridium perfringens Acute onset of abdominal cramps with
diarrhoea after 8-24 hours of ingestion.
Vomiting is rare
Vibrio Cholera Profuse non-bloody diarrhoea 8-24 hours
after ingestion, rice watery stool,vomiting
may be present.
Clostridium botulinum Descending weakness and paralysis starts 1-4
days after ingestion followed by constipation
Salmonella Abrupt onset of diarrhoea,low grade
feverabdominal pain ,vomiting 6-48 hours
after ingestion
5. 2)Traveller’s diarrhoea
Enterotoxigenic E.coli Acute onset watery diarrhoea 24-48
hours after ingestion,vomiting and
abdominal cramps may be present
Enteroaggregative E.coli Can cause bloody diarrhoea
Campylobacter jejuni Foul smelling watery diarrhoea followed
by bloody diarrhoea
Shigella Abrupt onset of bloody diarrhoea,cramps
tenesmus and fever 12-30 hours after
ingestion
Giardia Lambia Mild diarrhoea with nausea and abdominal
cramps 2-3 days aftyer ingestion
Enatamoeba histolytica Bloody diarrhoea,complicated by liver
abscess
Rotavirus Common with children,watery bloodless
diarrhoea,vomiting,low grade
fever,abdominal cramps
6. EXAMINATION FINDINGS:
BP 138|62 MMHG
PR 86 BPM, weak with low volume.
RR 20/min,Abdomino-thoracic.
Temperature 99 degrees Farenhiet.
SP02 90 % in RA
CNS GCS-E4V5M6
CVS S1S2 were heard,no murmur
P/A Soft, bowel sounds increased
RS B/L AE present , normal vesicular breath
sounds , fine basal crepitations
7. SIGNS OF DEHYDRATION:
Sunken eyes
Parched lips
Hollow temporal fossa
Tongue dry and coated
Lax subcutaneous tissue
Loss of skin elasticity
Pinched up nose
