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Gender: MALE; Age: 45 Years; Height: 5ft 7in; Body Type: Medium to Heavy
Blood Type: A Positive
Latest Update: Rajen is presently in ICU (he was moved to ICU from the Dialysis Ward on 10th Sep Night India Time) on account of Low Blood Pressure..
PRESENT CRITICAL SYMPTOMS & PARAMETERS (as on 10th Sep, 2008):
- Malena (Black Stools) being passed daily since last 3-4 days
- Persistent Coagulopathy, PT ranging from 28.4-30.9sec[normal range 12-18sec], INR 2.69-2.92.
- Continued state of Drowsiness, incoherent speech(last couple of days) {present Ammonia Level(GLDH, Kinetic) = 112 microgram/dl; normal range 27 - 102}
- Continued acutely low Platelet count ranging 35,000 to 49,000 [normal range 150,000 - 450,000] /cu mm
- Continued acutely low RBC count ranging around 1 - 1.5 [normal range 4.5 - 6.5] million/cu mm
- Continued low Hemoglobin levels ranging 5.2 - 7 g/dl [normal range 14 - 18]
- Low Blood Pressure reported of and on - Eg. 80/50
- Present Hep C virus levels are not known, however the last known virus load report received in Jan, 2008 had reported Hep C virus count of 847,000 IU/ml against a threashhold of <600>
PRESENT LINE OF THINKING BY THE ATTENDING DOCTORS:
1) The Gastroenterologist says that Liver is in failure. Presently no treatment is being administered for the Liver. After the Kidneys have stabilized and coagulopathy is under control, he plans to treat the patient with Interferon and stabilize or sterilize the Liver of Hep C virus and thereafter go in for Liver Transplant.
2) The Nephrologist has not been able to clearly ascertain the cause of acute Renal failure. Presently his Kidney functions are being managed by Hemodialysis (almost daily or once every second day). He is planning diagnostic Renal Biopsy once the coagulatory parameters have improved. Initially Peritoneal Dialysis (PD) was being proposed, but later the same was ruled out given the condition of the Liver.
PRESENT LINE OF TREATMENT BEING ADMINISTERED:
- Hemodialysis or HD is being administered every day or alternate day.
- Some of the main drugs being administered (not necessarily all being administered together, in the last 10-11 days at various points and various combination):
- HepaMerz
- Alburel
- Lactulose (DUPHALAC syrup)
- Hydrocortisone
- Solu Medrol Injection 1 gm
- Vitamin K
- Magnex 2G Injection (Sulbactam Sodium/Cefoperazone Sodium 1:1)
- Bioline 40 gm (Biofilter)
- Mannitol 20%
- Pantodac 40 mg Tab \ Peptilcer 40 mg Inj.
- Carnitor 1G inj 5ml
- Nutam (Piracetam)
- Ornida Tab ?
CASE HISTORY:
Rajendra Bhatnagar, born on May31st, 1963, was diagnosed with a Lupus (SLE) like syndrome in 1998. In 2000, he was given a blood transfusion, in view of his low platelet and hemoglobin count. In October 2007 he got infected with Typhoid. After treatment he got better but bloating of stomach and diarrhoea continued. His physician suggested complete check up. He was hospitalized for the same and Hep C was diagnosed. The cause was traced back to the blood transfusion in 2000. He was advised interferon and Ribaverin, but was also appraised of the risks of liver failure with the therapy. He refused this treatment and opted for Ayurvedic treatment.
With strict dietary restrictions and Ayurvedic treatment, his ascitis resolved and he was feeling good and energetic. Till April 2008, he was symptomfree and complaint free. His appetite was good and there was no further ascitis. Thereafter he started indulging in occasional alcohol drinks, meat, fried products and ghee. His medicine intake was also not regular. 4th week of June he complained of sever pain in the Right Hypochondriac region. An USG showed bilateral kidney stones. In end of June, the patient decided to go in for Homeopathic treatment on high recommendation of a complete cure for all his ailments in 5 weeks.. From beginning of July to 1st week of August, the patient was on Homeopathic medicines. During this period his condition worsened and he started having frequent bouts of fever, diarrhoea and distension. Tests done in the first week of August, after 5 weeks of Homeopathic treatment did not show any changes in the parameters, except the clearance of both the kidney stones. In the end of 2nd week of August he was again put back on Ayurvedic medicines, but the fever, diarrhoea and distension continued and that is why he was unable to take his Ayurvedic medicines on a regular basis. On 31st August, after a 2 day history of very low urine output (50-100ml in a day), he was admitted in Manipal in a state of acute renal failure. He is currently in Manipal and is being managed for Renal and Hepatic failure.
