A case of 65 yr old female with ASCITIS SECONDARY TO PANCREATITIS

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box
Pt came with C/O of abdominal distension since 6 days
And SOB since 6 days 
Pt was apparently asymptomatic 20 days back then developed fever and decreased urine output for 5 days for which went to local hospital and got treated ,fever subsided and then was asymptomatic for 4 days following which she developed abdominal distension over 5 days associated with secreased urine output  then went to local hsptl her creat was 4.6 she was kept under foleys following which urine was passed  and having shortness of breath grade 4  and they were discharged
From yesterday night developed abdominal distension  and sob at rest for which went to local hsptl they referred to our hsptl 
General examination 
Pt was C/C/C
No pallor cyanosis icterus clubbing lympadenopathy
Edema+
Temp 98.4
Bp 90/60 mmHg
Pr 88 bpm
Rr 25 cpm
Systemic examination
Cvs s1s2+
RS BAE +
P/A SOFT NON TENDER ,DISTENDED
CNS NAD
INVESTIGATIONS
Hb 12.0
TLC 19,800
PLT 5.95
RBS 126mg/dl
ESR 100 
LFT 
TB  1.95
DB 0.43
ALT 299
TP 5.9
Alb 2.7
RFT
Urea 195
CREAT 3.2 
Na 133
K 4.3
Cl 101
S amylase 584
S.lipase 289
Ascitic fluid
Sugar 65
Protein 4.3 
Amylase 333
Ascitic fluid cell count
TC 3750 CELLS
DC
70 % Neutrophils
30% lymphocytes


Clinical images






Fever chart

Provisional diagnosis
ASCITIS SECONDARY TO PANCREATITIS
With ?PRERENAL AKI with ?ALD
Treatment
1. NBM
2. Fluid restriction <1 Lt/day
3. Salt restriction <2 gm /day
4.inj cefotaxime 2m iv tid
5. Inj Rantac 50 mg iv od
6.IVF NS RL @ 30ML/HR
7. Inj tramadol 1.amp in 100 ml NS iv sos
8. Tab lasix.20 mg po bd


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