50 M with complaints of chest pain

THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 
Case 

53 yr old male with 
Chief Complaints of chest pain radiating to epigastric region since 2 days 

Patient was apparently asymptomatic till yesterday then he consumed 90 ml of alcohol and developed chest pain after sometime and then he noticed the pain radiating to epigastric region .
No h/o SOB , palpitations , sweating , vomiting 
The pain got aggravated on consumption of another 90 ml of alcohol today morning and then the pain relieved on its own and consumed lunch in the afternoon ,after 2 to 3 hrs of lunch he again experienced pain .
With bloating ,belching .
No h/o diarrhoea , constipation 

Not a k/c/o htn ,dm 2 ,tb, epilepsy.
He has a history of angioplasty dated 2009.
Personal history
Diet : mixed 
Appetite : normal
Bowel and bladder regular
Known alcoholic (details below) 

Daily routine
He studied till 10 th class and discontinued as he had to support family
He then did driving for 10 yrs , carpenter for 10 yrs and electrician which he is doing now For 10 yrs .
During his 20 s he started having alcohol ,smoking cigarettes daily for 10 yrs 
In 2009 he had an angioplasty and stopped consumption of both .
He went to hospital with complaints burning sensation in chest for 2 days .

General examination
Pt was conscious , coherent , cooperative
No pallor,icterus, clubbing ,cyanosis, lymphadenopathy,oedema

Bp 130/80 mmHg
Pr 76 bpm
Rr 16 bpm
Spo2  :98%

Systemic examination
Cvs : 

Precordium normal 
No thrills ,
On auscultation 
S1,S2 heard ,no murmurs 

CNS: 
Higher mental functions :intact
Cranial nerves :intact
Motor system:Normal power,tone,Gait
Reflexes:normal
Sensory examination:Normal
No meningeal signs
Tremors : absent

Rs: 
Shape of chest:Bilaterally symmetrical, Elliptical in shape
No visible chest deformities
No kyphoscoliosis,
Abdomino thoracic respiration, No irregular respiration

Trachea is central 
Auscultation: 
Normal vesicular breath sounds heard 

P/A
INSPECTION:

Shape of abdomen:Distended

Umbilicus:inverted

Skin over the abdomen is normal with striae.

All quadrants are moving equally with respiration

No visible peristalsis, Hernial orifices intact

External genitalia normal

PALPATION:

Temperature:Not raised
Tenderness: present in epigastric region and rt hypochondrium .
No Rebound tenderness 
No guarding rigidity
 No  organomegaly 

Percussion
No shifting dullness , 
No fluid thrill

Auscultation
Bowel sounds are heard.
Diagnosis
Alcoholic gastritis  with hypokalemia
K/c/o cad (angioplasty done in 2009)

Investigation
On 11/7

Serology : negative 

Troponin I :  12.8 pg/ml
At 6 pm 
Serum creatinine : 1.0 mg/dl
Blood urea : 16 mg/dl
At 10 pm

FBS - 92 mg/dl
HbA1c - 6.7%
PLBS - 135 mg/dl


Serum magnesium - 2.2 mg/dl



Ecg
On 12/7

Serum potassium 3.0 mg /dl

Serum magnesium 2.2 mg/dl



2 d echo
Usg abdomen 
Spot urine electrolyte
On 13/7

Blood urea : 13 mg/dl
Serum creatinine : 1.0 mg/dl



Serum calcium- 10.0 mg/dl

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