Ward round--A patient with multi-organ failure.
نویسندگان
چکیده
A 33 year old woman was admitted to the gynaecology ward in Queen Elizabeth Central Hospital with a four day history of abdominal pain and jaundice. She was 16 weeks pregnant in her third pregnancy. Both her previous pregnancies resulted in live, healthy children. Her health passport showed that she had been diagnosed HIV positive in 2008 during antenatal testing, although neither the patient nor her relatives were aware of her status and she was not taking anti-retroviral treatment. Three weeks before admission she had received treatment for malaria with quinine and had made a full recovery. She had no other past medical history. On admission she was jaundiced and looked unwell. She had oral candidiasis. There was no wasting, lymphadenopathy or signs of chronic liver disase. She was apyrexial, her blood pressure was 89/53, her respiratory rate was 40 breaths per minute with oxygen saturation 96% when breathing air. Her liver was tender and palpable 3cm below the costal margin. She had a clear chest and no other abnormal findings. She was alert and fully orientated. Later on the day of admission she developed a fever and was started on intravenous ceftriaxone 2g once a day. Her blood tests on admission are shown in the Table 1 below. On review the next day she was noted to be in respiratory distress with a respiratory rate of 52 breaths per minute and oxygen saturation 85% on air. Her blood pressure was 100/60 with a heart rate of 140 beats per minute. Her chest was clear. Her saturations improved to 97% on 4 litres/ minute of oxygen. On the third day of admission the patient had a spontaneous miscarriage, and a uterine evacuation was performed under paracervical block. Two days later she became unconscious with a Glasgow Coma Score of 5/15. She had equal pupils, no neck stiffness and no focal abnormality. No seizure activity had been witnessed. Further blood tests showed a raised serum creatinine concentration (see Table 1b). Her urine output was adequate throughout her admission. Urinalysis showed haematuria but no proteinuria. An abdominal ultrasound showed a normal liver, normal calibre bile ducts and swollen kidneys. An EEG showed diffuse generalized widening and slowing of waves, a pattern consistent with a systemic metabolic encephalopathy. [See Figure 1a. A normal EEG is shown in Fig 1b for comparison]. Fig 1a. Part of the patient’s EEG on day 6
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عنوان ژورنال:
- Malawi medical journal : the journal of Medical Association of Malawi
دوره 23 1 شماره
صفحات -
تاریخ انتشار 2011