Title:- 69 year old female having liver cirrhosis with diarrhoea
Disclaimer:-
This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here december 2016 after collecting informed patient consent (form downloadable here) by BMJ Elective Student.
Question :- will stopping diarrhea lead to accumulation of ammonia in brain causing sever condition?
Subjective
As said by patients's relative.
My wife had Hypotension and Hypoglycemia attack 16 years ago, and i had given her salt and sugar solution, and then she was admit and discharged in 3 days in good condition. She had Urinary Tract Infection 2 years ago, and she was admit in hospital, after 7 months again she had same infection and again was admitted then referred to higher center where she was admitted for 12 days.
She was having leg swelling, and also some swelling in body. CRP was high and not coming down. Sodium level used to fall.
She had this sodium level fall many times, and so she fell down, and while falling she didn't felt anything, but after falling she was able to feel that she have fallen down and have been injured.
Because of falling multiple times, her rib, leg, and hand broke.
once she was admitted to neurology and they said all is ok, then gynecology and again all was ok, then medicine department and discharged and then admitted to gastroenterology department and was diagnosed with Liver Cirrhosis stage 1st. Started avoiding oil and spicy food.
10 months ago Again sodium fell down. she used to have diarrhea and that also started again, 15-16 times a day and out of which 5-6 times in morning only, and occasionally some abdominal swelling, liver cancer doubted, referred to medicine then emergency then ICU.
Again recently she fell down, body was unable to move and abdomen swelling happened. stopped food, and having diarrhea 5 times in morning and total 15-16 times a day.
Objective :-
10 months ago she was diagnosed with liver cirrhosis, and lymphadenopathy and pneumothorax. She was suddenly falling and this was due to accumulation of ammonia in brain. Same have started happening again but also having diarrhea 15-16 times. She is also having ascites, difficulty in movement.
Examination:-
Percussion - fluid making dull sound in right side of abdominal region, and when position is changed, fluid also shift so dullness during percussion shift to different location.
No History of diabetes, and hypertension.
No History of diabetes, and hypertension.
AFP was normal when cancer was suspected 10 months ago.
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