AMC 4 th bed
34yr/M
A 34 yr male barber by occupation came to the opd with chief complaints of giddiness and fall 3 days ago 
patient was apparently alright 5 years back
in 2016- patient had jaundice,for which he used herbal medicine following which he had binge alcohol and severe loose stools,watery consistency (20 episodes/day) - for which he was admitted in outside hospital ,patient reports that he was in altered sensorium for 3 days in ICU during that admission (no records available).3 pints PRBC transfusion in ICU was done at that time of hospital stay.since discharge patient was fine and in 2018 patient went for regular check up ,he says blood investigations were normal at that time
3 days ago- patient c/o giddiness and fall in washroom with injury on left side of forehead ,then he went to a local RMP and on routine investigation was found to have pancytopenia and was referred here ,no h/o any ENT bleed , convulsions,LOC, blood loss during fall ,he complaints of generalised weakness since 1 month ,no c/o SOB ,body pains,joint pains,fever, bleeding gums,malena,hematemesis,vomitings,loose stools,pain abdomen,cough, tingling,numbness of limbs
past history
alcoholic since 15 yrs,drinks daily ,180-240 ml ,attenders report that whenever he gets free time ,he keeps on drinking alcohol and when he stops drinking alcohol for one day ,he reports craving and withdrawal symptoms (trmens).attendants complained that he drank alcohol even today before coming to hospital
DM(-),HTN(-)
personal history
appetite- decreased since 5-6 months
daily routine
wakes up at 8 am,goes to barber shop for about 1-2 hrs,goes to bar beside his barber shop ,comes home eats little food and sleeps.after waking up again goes to barber shop for 2 hrs ,drinks alcohol and comes back home ,eats dinner and sleeps
addictions- chews gutka 5-6 packets /day
alcohol- since 15 yrs daily
bowel movements- normal
micturition - normal
no significant family history
general examination
pallor-present
icterus- present
no clubbing,cyanosis, lymphadenopathy and edema
pulse-120/min
BP- 110/70 mmHg
spo2 - 98%
CVS
s1,s2 heard
RS :
BAE + ,NVBS
Abdomen:
soft,non tender
CNS: 
NAD
provisional diagnosis: Pancytopenia under evaluation
treatment
1) inj.thiamine 100 mg in 100 ml/NS/BD
2) vitals monitoring
3)watchbfor bleeding manifestations,SOB
4)Tab.Lorazepam 2mg po/HS

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