Suppression of appetite due to excess alcohol consumption

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CHIEF COMPLAINT:

A 65 year old man who is a laborer by occupation came to OPD with a chief complaint of :

-Decreased appetite since 4-5 months.

-SOB on exertion since 6 days.

-Generalized weakness.

HOPI:

The 65 yr old male patient was apparently alright 5 months back. Then he had complaints of decreased appetite. Patient is chronic alcoholic since 8 years which increased since 5-6 months, where he used to drink alcohol and skipped his meals.

Daily Routine: He is a daily laborer. He start his morning at 6:00 AM and complete his breakfast , usually he eats chapatti and goes to work. He avoids lunch and if he earn any wage , spends it on alcohol and go back to home and eat dinner of rice. He has stopped going to work from past 4 months as he was feeling very lethargic and couldn't walk much due to weakness. 

PAST HISTORY :

10 days back, he had c/o facial puffiness , pedal edema for which he went to a hospital and was found to have anemia.

No H/O blood loss due to trauma/blood in stool 

No H/O worm infestation

No C/O chest pain, syncopial attacks, orthopnea

No K/H/O Diabetes Mellitus, hypertension, asthma, epilepsy, CAD, CVA 

FAMILY HISTORY:

There is no similar complaints in his family.

PERSONAL HISTORY: 

Married 

Occupation: Daily laborer 

Diet: mixed

Appetite: lost

Bowel and bladder movements: regular

Micturition: normal 

Socio- economic: poor

Sleep- adequate

Habits - Alcoholic (180-360ml whisky/day)

GENERAL EXAMINATION:

The patient is examined in well light room. He is conscious, coherent and cooperative and well oriented to time, place and person and consent was taken to examine him.

Pallor - +

Icterus -Absent 

Cyanosis -Absent 

Clubbing -Absent 

Lymphadenopathy -Absent 

Pedal Edema -Absent 

Nails- appears brittle, koilonychia.

Dehydration: absent

KOILONYCHIA (SPOON SHAPED NAILS) SEEN IN THE LOWER LIBS

VITALS:

Temp: 98.6°F

B.P: 110/70 mm Hg

PR: 82 bpm

RR: 18/ minute

GRBS: 110mg%

SPO2: 98%

SYSTEMIC EXAMINATION:

CVS:

S1 and S2 are heard

no thrills and no murmurs

RS:

Dyspnea - absent

Wheeze- absent

position of trachea- central

Breath sounds- vesicular 

Abdomen:

Scaphoid shaped abdomen, 

non tender & no organomegaly detected

CNS:

Conscious and normal speech

normal gait

cranial nerves are intact

sensory system is normal

motor system is normal

reflexes are normal

INVESTIGATIONS:

Hemogram:

HB: 3.8 on 5/11/22

4.6 on 6/11/22

6.9 on 7/11/22

7.2 on 8/11/22

USG:

USG IMPRESSION: BILATERAL GRADE1 RENAL PARENCHYMAL DISEASE CHANGES

WITH SIMPLE RENAL CORTICAL CYST IN LEFT KIDNEY

ECG:

PROVISIONAL DIAGNOSIS:

Iron deficiency anemia secondary to nutritional cause.

TREATMENT PLAN:

Tab Orofer-Xt PO OD

Inj. Iron sucrose 100mg in 100ml NSIV OD

Inj. Ferric Carboxymaltose 500mg in 100ml NSIV STAT

Syrup Aristozyme 15ml PO TID

Blood transfusion done on 5/11/22 10:00PM

Blood group B positive

Monitoring of Vitals

Q. How does alcohol affects iron metabolism?