Acute-liver-failure

2.  Name: Tabindah
 Age : 3 ½ years
 Birth order : Ist
 R/o : Manigam, Ganderbal
 Religion: muslim
 Habitation; Rural
 Belonging to : Joint family of 5
members
 Informant: father

3. th




Income : Rs 5000 per month
Education (HOF): 8 class
Occupation (HOF): Skilled worker
S.E Class: Lower middle class as per B
G Prasad classification 2014

4. 


Loose stools 5-6 episodes * 1day.
Pain in the abdomen
Nausea* 1 day

5.  As per pt.’s informant the child was in
usual state of health 1 day back when she
started with pain in the abdomen with an
episode of loose stools during the day.
 Followed by loose stools 5-6 episode in
2-3 hours with nausea .
 Pain was colicky in nature involving whole
abdomen

6.  NO H/O: Vomiting, blood in stools,
Fever, Refusal to feeds, Drowsiness,
Convulsions, irritability, decreased urine
output.
Past history: Not significant.

7.  Type of delivery: NVD
 Place of delivery: SKIMS
 Birth weight: 3kgs
 Antenatal history: Mother receivedANC
from the SKIMS only. Immunized against
T.T., received iron-folic acid
supplementation and used to go for
antenatal visits regularly. The antenatal
period was uneventful.

8.  Feeding history: Breast feeding started
after birth and up to 8 months baby was
exclusively breast fed. There is no H/O
any prelacteal feeds.
 Frequency of breast feeding: on
demand

9.  It was started after 8 months with ¼ cup
of mashed rice in milk,2 -3 biscuits with
tea and ¼ of an egg and ¼ of a cup of
cerelac. The frequency of complementary
feeds were 2 to 3 times a day in addition
to breast feeding which continued up to
2.5years.

10.  She is taking 1 home made chapati with 1
cup of salt tea in the morning and then at
11 o’clock ½ baked Roti with sugar tea
and ¼ plate of rice with soup or mashed
vegetables in the lunch, in the evening
1cup of salt tea with home made chapati
and at dinner ¼ plate of rice sometimes
vegetables. Some times fruits but not
regular.

11. MEAL Food Item Consumptio
n/day
Calories
(kcal)
Proteins
(gm)
Carbohydrat
es (gm)
Fats
(gm)
Iron
(mg)
Calciu
m (mg)
Breakfa 1 cup salt tea 150ml 33.5 1.6 2.2 2.05 0.1 60
st +
8am 1 chapati 40 gm 136.4 4.84 27.6 .68 1.86 -
10 am 1 roti /
1 sugar tea
37 gm
150ml
128
50.5
4.5
1.605
26
7.17
.63
2.35
1.8
0.1
-
60
Lunch Rice 1/4cup + 37.5 gm 129.4 2.55 29.3 .19 0.26 -
2pm 1 bowl
Cauliflower 25gm 7.5 .65 1 0.1 0.35 8.25
Banana (2
No)
232 2.4 54.4 0.6 0.72 20
Afterno 1 cup salt tea 150ml 33.5 1.6 2.2 2.05 0.1 60
on +
5pm 1 chapati 40 gm 136.4 4.84 27.6 .68 1.86 -
Dinner 1 /4 plate rice 37.5gm 129.4 2.55 29.3 .19 0.26 -
9pm
TOTAL 1017 26.4 206.6 9.52 7.41 208.25

12. Energy requirement of case = CU x 2400 kcal
= 0.5 x 2400
= 1200 kcal
Nutrient Percentage of total
energy required
Requirement (in gm)
Protien 15 % = 180 kcal 45 gm
Fat 20 % = 240 kcal 26.65 gm
Carbohydrate 65 % = 780 kcal 195 gm
12

13. KCAL CARB
(GM)
PROT
(GM)
FAT
(GM)
IRON
(MG)
CAL
(MG)
TOTAL DAILY
REQUIREMENT
{RDA}
1200 195 45 26.65 10 500
TOTAL CONSUMPTION 1017 206.6 26.4 9.52 7.41 208.25
DEFICIENT / EXCESS 183
( D )
11.6
( E)
18.6
( D )
17.13
( D)
2.60
( D )
291.75
( D )

14. 



child has achieved all milestones at
proper age till date.
Motor development: was running here
and there.
Personal-social development: knows
gender
Adaptive development: ask for foods
Language development: was able to
speak simple sentences.

15. 


Immunization history: child is completely
immunized as per EPI schedule. Socio-
cultural history: practices of not giving
certain foods during diarrhea is not
present.
Environmental history: the family resides
in a single story house having 4 rooms and
a lobby. kitchen is separate, separate
washrooms with good drainage system and
ventilation. Over crowding is absent.

16. 

Personal hygiene: satisfactory
Health seeking behavior: They visit
SKIMS hospital , district hospital
Ganderbal for major and minor ailments.

17.  Examination: Pt. is conscious,
cooperative, oriented to time, place
and person.
 WT: 14.5kgs
 HT: 96cms
 HC: 50 cms
 CC: 55cms
 MAC: 18 cms

18. 



THE child is having normal wt. /age:
14.5kgs (11.3 – 19.2kgs) as per WHO
standards
Ht. /Age: 96cms (89.8 – 105.7 cms )
normal as per WHO standards
Wt. /Ht. % = Wt. of child/Wt. of a normal
child at same ht. X 100
14.5/14.6 x1oo = 100% (>90%)

19.  Vitals:
 Pulse: 86b/m
 R/R: 22 b/m
 Temp: 100 f
 B/P: not recorded
GENERAL EXAMINATION:
 CONDITION: Conscious ,oriented, alert
 Eyes: Normal Feel: Skin Pinch


Tongue: Moist (Goes back instantly)
Thirst: Not thirsty

20.  Head and face:
Anterior fontanel: closed
Pallor
No Icterus
odema
Ear, Nose and Throat: Normal

21. 


Neck: No LAP
Skin and Appendages: Normal
Systemic Examination:
 Respiratory system:
 Inspection: Shape normal
No abnormal breathing
movements
No chest in drawing


Palpation: Normal
Percussion: Normal

22. Auscultation: B/L air entry Normal, No added
sounds, strider/wheeze
 CVS: S1, S2 heard, no added sounds
 Abdomen:
 Inspection: no scar or visible mass
 Palpation: no organomegaly
 Auscultation: Bowel sounds heard

23.  Diagnosis: DIARRHOEA WITH NO
DEHYDRATION

25.  Treatment: ORS
Zinc
Probiotic
Advice Given:
 At individual level:
 Advice on increased dietary intake to meet
the demands of growing child


Deworming every 6 months.
Food Hygiene

26. At family level:
 Keeping food and water clean
 Washing hands before eating & after
defecation.
Fly control