Sunday, July 14, 2013


    I wrote about the allergic reaction to commonly use medicine aspirin , and it almost killed patient . No one was at fault and no one made any mistake or wrong decision . There was no malpractice . But it was just a ' chance  '.Many a times common public can not understand , that this was just a bad luck .I am going to tell about an another case of similar situation .
    I was called at 9-30 pm to see a patient who was short of breath and then when I called them back ,I came to  know that he was being transferred to  ICU as the blood pressure was low . As I got in the car to go to see patient , I had called the admitting doctor . He told me that the patient was admitted to hospital at about 4 am that day and he had seen the patient that morning and he was doing OK . Now with the shortness of breath and low blood pressure he was being transferred to ICU . I called the ICU nurse and got some general idea . She had not assessed the patient as he was in  ICU  for less than 5 or 10 minutes . I gave some general ordered to get the labs going and managed the low blood pressure ..As I was getting in the parking lot of the hospital , I had realized that I was going to need a general surgeon to see patient that night, and that too ASAP . I called the surgeon .
     I went to ICU and evaluated the patient . He was 44 years old white male , who had flu like symptoms for about 2 or 3 days and he had taken over the counter remedies . He had some fever and some cough . When he did not get better , he came to ER . He also was having some belly pain . In the ER he had abnormal liver function and mildly elevated white cell count , suggesting infection .The admitting doctor had ordered the gall bladder studies and they came back negative . He was started on IV fluids and was given broad spectrum antibiotics .He felt little better . But then when new team came in at 7 pm and the nurse did her evaluation , she noticed low normal blood pressure . She called the doctor and got orders for some labs and more IV fluids . The next evaluation , his blood pressure was lower and so it was decided to transfer him to ICU and I was called .
    On examination he was quite tender in right upper quadrant of the belly , where liver and gall bladder are present . He had gotten lot of fluids and as his blood pressure was still low , we started him on medicines -to bring it up . By then the labs came back . He=s white cell count had further gone up and his liver tests were also worse . He was not responding to the blood pressure medicines and I had to add different medicine . He was not putting any urine and it showed in the blood chemistry . He was in kidney failure  too. I had anticipated it and had put a call to a kidney specialist too . The surgeon came in and so did the kidney specialist . We discussed the case , and decided to talk to his waiting family , the wife and a daughter . I felt that there was no choice but to open him up and see as to what was going on in the gall bladder or liver or for that matter in the abdomen . The concern that the surgeon was that , he may not tolerate the anesthesia or the surgery and may die on the table . We discussed the pros and cons of the choices that we had . In between I had decided that with his general condition worsening , we needed to put him on a breathing machine. The surgeon wanted to talk to a vascular surgeon , so he can come in the operating room , once he was little stable and assist him , in case there was a vascular issue that was causing the problem . The wife and the daughter wanted to see him . As I entered the ICU with family and the surgeon , I saw that his blood pressure was dropping and now the heart rate was dropping too . We called in  CODE . We tried to work on him for next 40 0r 50 minutes , but he never came out . He died . I was in ICU for about 2 hours . I had no idea as to what did he have . I explained it to the family and requested an autopsy . She agreed .
      The autopsy was done . I spoke to the pathologist . According to the pathologist patient had acute necrosis of the liver , most likely due to excessive use of Tylenol . There was no gall bladder problem , there was no vascular issues and certainly no major lung or heart problem . I had gotten the history of taking over the counter products , including several Tylenol. So the best conclusion that I could come with and the pathologist agreed , was that he took too many Tylenol and he also use to take 3 to 4 drinks a day . So the combination of the Tylenol and alcohol, both very commonly taken things , killed him  !!!!

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