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This document summarizes the medical record of a 35-year-old female patient who presented with loose stools, vomiting, weakness, inability to walk, and fever for 3 days. On admission, she was conscious but weak. Her condition deteriorated over the next two days despite treatment. On the second day, she became unconscious with low blood pressure and heart rate. Efforts were made to resuscitate her but she was declared dead without vital signs or heart activity. The immediate cause of death was determined to be metabolic acidosis with severe dehydration due to acute gastroenteritis.
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
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Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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- 1. DEATH REVIEW PATIENT Patient details:- Name of deceased –Sahenoor Age -35yrs , female Date of admission – 16/12/22 Time -06:44PM
- 2. Chief complaint • Loose stools 3-4 episodes.( since 3 days) • Multiple episodes of vomiting( since 3 days) • Generalised weakness( since 3 days ) • Inability to walk ( since 3 days ) • Fever on and off since 3 days
- 3. History of Present illness • Patient presented with loose stool 3-4 episodes per day since 3 days ,insidous in onset , large amount non foul smelling , patient also complains vomiting , vomitus containing food particles and non – projectile in nature • Patient also complain of inability to walk ,insidous in onset & gradually progressive , patient also complain of fever , insidous in onset , low grade & intermittent ,not associated with chills & rigor .
- 4. General –physical Examination • BP-110/80mmhg • TEMP-98.f • RESP. Rate-28/min • Pallor ; Present • Icterus- ,Cyanosis-,Edema-, Clubbing- ALL ABSENT • Pulse -118/min • RBS-167 mg/dl • Spo2-97% room air.
- 5. Systemic examination • RESIPATORY SYSTEM – B/l Air entry present , normal vesicular breath sound present • C.V.S- S1 & S2 present , no murmur. • Per Abdomen- No tenderness, No oraganomeagly. • C.N.S- conscious & oriented to time , place , person , all cranial nerve are intact & are within normal limits, • POWER B/L upper limb : 5/5 B/L Lower limb : 3/5 • Plantar B/L flexor
- 6. Investigation & Advice • Investigation:- • CBC • LFT urgent • KFT • Viral Serology HCV/HIV/HBsAG • Lipid profile • Blood Sugar FF/PP • Urine R/M • Chest X-Ray PA view • USG whole Abdomen • Investigation done in emergency • ABG, ECG, Chest X-ray PA view ABG SHOWS PH -7.3 pco2- 16 po2 -132 HCO3-13 BEecf: -17.9 k+ : 1.6 Sodium: 141
- 7. Treatment advise on admission day 1 •Inj ciplox 100ml IV BD (APST) •Inj metrogyl 100ml IV TDS (APST) •Intravenous fluid 2 units NS 2 unit RL 500ml over 24 hrs •Inj pantop 40 mg IV OD/BBF •Inj ondem 4mg IV TDS •ORS sachet 1 sachet in 1 liter of water in sips •Tab pcm 650 mg 1 tab sos
- 8. Day -1 • 161222 Time 11:00 pm • GC-poor • Patient is drowsy disoriented and tachypanic and gasping • On examination • BP -NR • PR -42bpm • Spo2- 48%@10litremin on oxygen • Intubation done Ventilator settings • Fio2 100% • VT 400 • RR 16 • PEEP 6 • I:E 1.1 ABG SHOWS after 2 hrs of intubation PH -7.25 pco2- 29 po2 -387 HCO3-12.7 Beecf :-14.5
- 9. • AFTER INTUBATION – • Vitals – • BP -11063 mmhg • PR-136bpm • SPO2-100% @ fio2 -100% on ventilator • RR-30 minute o ADVISED TREATEMENT- NEBULIZATION WITH DUOLIN AND BUDECORT STAT injection kcl 2 ampule in 500 ml ns over 4 hours. IVF 3 units RL and 2units NS and 1unit DNS given over 24 hourly. Monitor input output.
- 10. DAY2 vitals BP -7050mmhg PR -122bpm spo2-99% with ventilator support with ippv mode with fi02 60% SYSTEMIC EXAMINATION CNS – unconscious, disoriented CVS –S1,S2 audible , no murmur R|S – B|L air entry present , normal vesicular breath sound present P|A – soft , non tender investigation advise- ABG serum electrolyte ESR CRP ABG SHOWS PH -7.23 pco2- 25 po2 -303 HCO3-10.5
- 11. TREATMENT ADVISE .IVF – one unit NS 500ml iv over 15 mins .injection norad 2ampule in 46ml ns @5ml per hour .inj –kcl 2ml in 500ml NS over 4hours .inj piptaz 4.5gm IV TDS in 100ml NS over 30 mins .hold injection ciplox 100mg
- 12. ALL VITALS are non recordable CPR given accorfing to ACLS protocol On examination – peripheral pulses are not palpable. Carotid pulses not palpable. Heart sound not heard. B/L pupils dialated and fixed ECG shows no electrical activity Immediate cause of death : METABOLIC ACIDOSIS WITH SEVERE DEHYDRATION Due to : ACUTE GASTROENTERITIS
- 13. Thank you