Sunday, September 6, 2009

What could be her diagnosis?

"Doctor, I have a patient in shock [very low blood pressure]. Please see her and give your opinion".

The Gynaecologist of my Hospital was asking me on the hospital phone.

"How come you were called first"? I asked. A patient in shock is my area.

'She happened to be 3 months pregnant" was the answer.

I was soon in the intensive care by the patient's bedside.

She was 24 years old, mother of a 2-year-old child. She developed high-grade fever and was admitted in another small hospital nearby 4 days ago. She was discharged yesterday as she was apparently all right. Early this morning she developed tummy pain, vomiting and drowsiness and was admitted to my hospital.

She was really sick. Though drowsy she answered my questions. During her previous admission she only had fever and headache. No cough or breathlessness or loose stools. There were no joint pains too. Now from last night she is having vomiting, extreme tiredness and tummy pain.

On examination there was no fever. She seemed to have distension of her tummy more than that is expected of her 3 months of pregnancy. Her chest [lung] expansion was also less and the oxygenation low. Blood pressure was only 70/50 with almost no urine output for last 4 hours though her urinary bladder was catheterized.

By the time I saw her 3 pints of intravenous fluids had been transfused with no increase in blood pressure.

Is it a ruptured ectopic pregnancy?

A patient in early pregnancy coming with tummy pain and very low blood pressure should be considered as a ruptured ectopic unless proved otherwise.

I know the Gynaecologist must have ruled it out already before referring to me.

Yes she has by an ultra sonogram, which showed normal uterine pregnancy with a live foetus.

Ultra sonogram also showed moderate amount of free fluid in the peritoneal cavity and also in both sides of the chest inside the pleural space. That explains her abdominal distension and reduced lung expansion.

Now I looked at the lab results. Total WBC count is 3400 with 80% neutrophils while the Platelet count was 90 thousand. Both low. The Packed Cell Volume was 39% with a normal ESR. The liver enzyme SGPT [ALT] was high at 1050 with SGOT [AST] at 350. Rest of the lab values were normal. ECG was normal too.

What could be her diagnosis?


Anonymous said...

Waiting for a follow up post. This looks scary.

Indy said...

Oh my God! that's bad! Your blog is so good,full of useful information!Must add yours to my links! :)

Charakan said...

IHM, Soon will post the second part.
Welcome here Indy and thank you.