30 yr make with c/o pain abdomen and vomiting since 3 days

30 yr male with C/O pain abdomen since 3 days 

Vomiting since 3days 

Fever since 2days 

Decreased urine output since 2 days 

Patient was apparently asymptomatic 3days back then he developed pain in epigastrium and left hemichondrium,colicky type,non radiating ,no aggravating and relieving factors

Associated with vomitings since 3 days 5-6 episodes per day watery immediately after food intake non bilious nonon blood stained

No h/o loose stools

C/O fever since 2 days,high grade intermittent ,not associated wirh with chills and rigor

No h/o cough ,cold,chest pain,sob ,pedal edema

C/O decreased urine output and high coloured urine since 2 days

Patient got admitted in local hospital in view of pain andomen and and vomiting and was referred here in view of decreased urine output 

Not a k/c/o HTN  DM TB asthma CAD 

After 2 days of admission his bp raised to 170 /90 from then he is having intermittent high bp

He is chronic alcoholic since 6 yrs he has binge intake of alcohol 3 days back

No signs of pallor icterus cyanosis clubbing  lympadenopaty  pedal edema 

Temp.101 degree F

Pulse 145 bpm

Bp 120/80 mm Hg

SpO2 99%

RR:18/MIN 

GRBS 128

Per abdomen 

Shape of abdomen   scaphoid 

Tenderness is epigastrium and right hypochondrium

Guarding present

No palpable mass 

Hernial orifices free

No organomegaly 

Bowel sounds +

Serum amylase 319

             Lipase 96.6

Rft

Serum urea 286

             Creatinine 11

Uric acid 13.9

Na+ 130

K+2.7

cl- 96

Lft 

TB 2.63

DB 0.71

Ast 93

Alt 157

Alp 212

Tp 6.5

Albumin 3.8

A/G ratio 1.43

Hemogram 

Hb 11.3

Tc 9100

Platelets 1.30

Esr 20 

LDH 599

CK 127

Treatment given:

1.NBM

2.IVF

3.INJ.PAN40mg/iv /BD

4.INJ MONOCEF 1 gm /iv /BD

5.INJ METROGYL 500 mg/iv /TID

6.I NJ THIAMINE 

7.I/O CHARTING 

8. GRBS 6 th hrly 

Pt shifted for hemodialysis in view of aki

Hemodialysis was done 3 times after which his RFT became normal

2 Days after admission meropenam was started in view of raised TLC to which pt responded well

Started oral liquids 3 days after admission 2 days latter started soft diet