Hypoglycemia

Based on complaints of weakness and cold sweat. On capillary GDS examination is

25 mg/dl. Hypoglycemia in this patient may be due to cirrhosis hepatic.
Diagnostic Plan : -
Therapy Plan:
• Pure suga
Monitoring Plans:
• Recheck GDS 15 minutes later,
• If GDS < 50mg/dl, pure sugar 30gr orally
• If GDS < 100mg/dl, pure sugar 30gr orally
• If GDS 100-200mg/dl, Maintenance D10% 20 tpm
• If GDS > 200mg/dl, consider lowering drip rate D10r 30gr/oral
Education Plans:
Education about the disease, examination plans and management
Melena et causa Suspected Variceal Bleeding

Based on complaint melena. On rectal touch examination, it was found

that there was no inflammation, no tumor mass, the anal sphincter was
suffocating, the ampulla did not collapse, the mucosa was smooth, the
stool was soft the color is black, and there was no fresh blood. Melena
in this patient may be caused by bleeding esophageal varices/variceal
bleeding caused by cirrhosis of the liver. However, it has not yet been
established and requires further investigation.
Diagnostic Plan:
• UGIE (Upper Gastrointestinal Endoscopic)
Therapy Plan:
• Ocreotide bolus 50mg/intravenous ---> 25mg/hour/SP
Monitoring Plans:
• Bleeding monitoring
• control Routine blood
Education Plans:
Education about the disease, examination plans and management
 Grade 3 hepatic encephalopathy

Based on complaints of restlessness at the patient. Based on the West

Haven criteria, this patient was admitted with somnolence, confusion
and emotional disturbance.
Diagnostic Plan:
• blood ammonia
Therapy Plan:
• Branch Chain Amino Acids 500cc/24hours/intravenous
• Lactulose syrup 30cc / 8 hours / orally (NGT)
• Lactulose klisma
Monitoring Plans:
• Monitoring vital signs and consciousness

Education Plans:
• Education regarding the condition of the disease, the disease
suffered, the examination to be carried out and the management plan.
 Normochromic normocytic anemia et causa
Gastrointestinal bleeding

Based on complaint of weakness. The patient also complained of

having black bowel movements since 1 day ago. On physical
examination, anemic conjunctiva was found. On investigation, anemia
with Hb 8.8 with Mcv 96, Mch 32 was found. In this patient, it is
possible that anemia is due to gastrointestinal bleeding.
Diagnostic plan : -

Therapy Plan:
• Transfusion of PRC 2 bags if Hb < 8gr/dl
Monitoring plans:
• Monitoring vital signs and clinical
• Evaluate signs of bleeding
• Monitoring of transfusion reactions

Education Plans:
• Education about the patient's condition, course of the disease, and
follow-up examinations that will be carried out
 Sepsis Shock, Sepsis SOFA Score 15
Based on decrease in consciousness, hypotension and the presence of
shortness of breath. On physical examination found GCS 11 (E3V4M4),
blood pressure 80/50 and respiratory frequency 26x/min. From the
results of these examinations obtained SOFA Score 15. In this patient
the cause of infection is likely from SBP.
SOFA Score table
Criteria Evaluation Scoring
Respiration 397.5 1
Coagulation PLT 106.000 1
Liver Billirubin 33.26 4
Cardiovascular on Norepinephrine 0.05 3
CNS GCS 11 2
Renal Creatinine 9.98 4
Total 15
Diagnostic Plan:
- Check blood lactate and procalcitonin
- Blood culture
- AGD
- Billirubin

Therapy Plan:
- Antibiotics according to blood culture results
- Vasopressor : Norepinephrine 0.08mcq/KgBW/min/SP (Uptitration)

Monitoring Plans:
- Monitoring general condition, awareness and blood pressure.

- Education Plans:
- Education about the patient's condition, as well as examination and treatment plans