our doctor today in his first day in emergency department with his senior , the time is pre-night
he want to learn more because pre-night loaded with many cases
senior said : actually 1% is really cases , and 99% divided in conversion disorder (hys) , medical-police reports , flu metastasis to bone , alcoholic patients , oh today is Thursday , they will come (alcoholic)
1st case ( hypoglycemic alcoholic patient )
1 hr later , alcoholic case with confusion , palpitation , sweating
RBS 40mg/dl
senior advice to give hypertonic dextrose 50%(25g) 20cc iv (dose 0.5-1g / kg )
also never give glucagon to alcohol induced hypoglycemia , glucagon induce glycogenolysis in liver and alcoholic pt are glycogen depleted patient
2nd case ( wernicke encephalopathy )
other case with same symptoms , the rotater doctor give him hypertonic dextrose 50% without improvement , and case deteriorated , senior advice to give 100mg thiamine iv (wernicke encephalopathy) , and advice our doctor that this patient will deteriorate if give him glucose , finally he improved at thiamine
3d case ( alcohol withdrawal patient )
alcoholic case , agitated , confused , our doctor give him glucose 50% and thiamine and the case still the same , he take detailed history , the history reveal that the patient decided to withdraw alcohol drinking since 2-3 days ago and he was heavy drinker , so this case alcoholic withdrawal patient , senior advice to give benzodiazepine
4th case (hepatic encephalopathy )
very confused patient , history of alcohol intake but last intake was 4 years ago
doctor gave him glucose 50% /thiamine 100mg / diazepam , the patient become comatose (the rotater told the senior ) , on detailed history , the patient had history of liver cirrhosis , so senior say that case of hepatic encephalopathy due to liver cirrhosis , and advice the rotater dont give diazepam to those patients
supportive care started , neomycin-lactulose-flumazenil(benzodiazepine antidote)