Death Discussion

Dr. Nahid Farzana

Medical Officer

MU- XI

Duration

From 02/10/2009 to 08/10/2009

Total No. of Admitted Pt. 27

No. of Current Death Nil

Carried Over Death 01

Disease pattern

Diseases No. of PatientsBronchiolitis 05Pneumonia 01Perinatal Asphyxia 05Preterm Low Birth Weight 01Neonatal Sepsis 02Meningitis 02Acute Gastroenteritis 03AGN 01Nephrotic Syndrome 02Epilepsy 01

CP with Pneumonia 01Down’s syndrome with pneumonia 01Viral Hepatitis 01Acute Abdomen 01

Distribution

< 1 month

>1 mo. to <1 yr

> 1 yr

Male

Female

Age Distribution Sex Distribution

Case Summary

Farzana , a 5 yrs old girl hailing from Joydevpur admitted on 31st March 2010 at 2.00 pm with the complains of irregular fever and multiple swelling in neck and behind the ear for last 2 yrs and multiple abdominal mass for 1 month. She had history of treatment with anti-TB drugs and course was completed 6 months ago.

Case Summary contd.

Anti-TB drugs were restarted 1 month back as per advice by a qualified physician.

On examination the girl was ill looking , severely pale, edematous, regarding vitals pulse -110/min. RR.- 40/min. temp 1020. There was bilateral basal crepitation. There was generalized lymphadenopathy involving cervical , axillary, inguinal regions, largest one measuring 5x5 cm , non tender, discrete, rubbery in consistency, free from overlying skin.

Regarding alimentary system examination, there were multiple nodular mass involving left hypochondriac, umbilical and left lumbar region, non-tender .Liver was enlarged 4 cm from Rt. Costal margin in the rt. Mid clavicular line, mildly tender, soft in consistency.

She was accompanied with a FNAC from lymph node which showed granulomatous lesion consistent with tuberculosis .

Case Summary contd.

Provisional Diagnosis

Lymphoma

Differential Diagnosis

Disseminated TB

Investigations sent

Blood group CBC with film Liver function test S. urea and Creatinine Chest X rayPlan

• USG of Whole abdomen

• Open biopsy of lymphnode

Treatment on Admission NPO Propped up position O2 inhalation Inf. 10% Baby Saline Inj. Ceftriaxone Syp. Paracetamol Arrange for blood transfusion

Consultation with Dept. of Hematology and oncology done and they suggested for lymphnode biopsy.

Follow upon 31/03/2010 at 10 pm

Pt. developed orthopnoea

O/E

HR- 160/min with Gallop rythm

Rx

• Continue previous treatment

• Inj. Lasix

• Packed cell transfusion

Follow upon 01/04/2010 at 9.00 am

O/EModerately paleHR -120/minRR—30/min

Heart-s1 s2 audibleLungs- Bilateral basal

crepitationAdv.:

MT

Rx

Continuation of previous treatment

Packed cell transfusion

Investigations CBC with Film

• Hb 6.5gm/dl

• TLC 15,300/cummDLC

• Neutrophil 83%

• Lymphocytes 10%

• Monocytes 01%

• Eosinophil 01%

• Band form 05%

• Platelet 2,43,000/cumm

• Film

• Hypochromia, anisocytosis, increased neutrophil with toxic granules

Investigation

Blood Group “O” positive B. urea 5.8 mmol/L S. Creatinine 37.3 umol/L S. Electrolytes

• Na+ 133.3 mmol/L

• K+ 3.7 mmol/L

• Cl_ 85.7 mmol/L

SGPT 103 U/L S. Alk.Phos. 660 U/L

Follow up on01/04/2010 at 4.00 pm

O/E

Dypnoeic

HR 130/min

RR 50/min

Temp. Normal

Rx

Previous treatment continued

Follow up on02/04/2010 at 4.00 am

O/E

Gasping respiration developed

HR - 42/min

L-Air entry- poor

Temp –

Rx

Previous treatment continued

CPR started Inj. Adrenaline

Follow up on02/04/2010 at 5.30 am

O/E

Gasping continued

Pupil fixed and dilated

HR- unrecordable

Plan

ABG

Rx

CPR continued

Follow up on02/04/2010 at 6.00 am

O/E No sign of self respiration No cardiac motion Pupil widely dilated, fixed, non reacting to light No response to painful stimuli.

So the patient declared dead at 6.00am due to irreversible cardio-respiratory failure as a consequence of Lymphoma with metastasis with Heart failure.