(iovt. of Naional Capital Territory of Delh!

MUNICIPAL CORPORATION OF DELH

HY AHyI qDeath Certificate

0224-240 2217181

(Issued under section 17 of the

of Death Rule,1999) Registration of Death Act, 1969 and 8/13 of Delhi Reg istration

Inis 1S to Certity that the

DEATH which is the registerfollowing
for
info rmation bas been ta ken from
Municipal Corporation 0f Delhi or
the original recOrd o
SOUTH ZONE of
N.C.T. Delhi

HH /Name
ARUN KUMAR
f /Gender MALE
HY ot ftt/Date Of Death 14/02/2024
HY ¢T FATT / Place Of Death INSTITUTE OF LIVER AND BILIARY SCIEN CES D-1
VASANT KUNJ NEW DELHIVASANT KUNJ
(KISHANGARH) D-1 TO D-6 SOUTH DELHI INDIA
110070
yut ôi fife / Date Of Reg istration 24/02/2024
joto HAT / Registration No MCDOLIR-0224-2402205512
HTI OT TH /Name of Mother SAKUNTI DEVI
fyat T AH/Name of Father RAM CHANDER YADAV

GtaTeft T TTH /Name of Spouse JOYTI RAI

OTR NO 366 THIRD FLOOR M.B. ROAD
SECTOR 5
Present /Address at the time of Death) TYPE 2 PUSHP VIHAR SOUTH DELHI
INDIA 110017
FYTS YaI /Permanent Address RANIGANJ NISURPUR TEKARI GAYA BIHAR INDIA
824236

G fafe / Date of Issue 24/02/2024

S9oti Rai
11)3 ]24
ENSURE REGISTRATION OF EVERY BIRTH &DEATH
is system generated
and does notrequire any seal/sig
No te: This certificate nature
of this certificate can beverified at mc donline.nic in in original. The authe ntic ity
 INSTITUTE
(An OF LIVER &BILIARY
Autonomous Society under SCIENCES
|WDS Phone No: Government t of NCT of Delhi)
D-1,Vasant Kuni. New
011-46300000 70558 7056.Delhi,
Ext. India
Fax No.46300010011-26706700 02, 040
- 4CCREDTE

Email : info@ilbs in, Website:

http:/lwww.ilbs.in
Patient
ARUN KUMAR Death Summary
Age 43 Year(s) UHID ILBS 0000310562
Gender IPID.0097688
|Male npatientNo
Ward
Liver \CUPhase Il |Admission Date 27 Jan 2024 09.22 AM
Speciality Hepatology Unit 2 Discharge Date. 14 Feb 2024 01:38 PM
Bed No Death Date 14 Feb 2024 10:21 AM
2369-19
DIAGNOSIS:
Portal Hypertension: Non Bleeder Smallresidual varices with
[9/1/23] scarring, mila rno
Cirrhosis of Liver: Ethanol related (Last Intake3 years back) [ ICD
K-70.9J
Decompensated:
MELD - 34 CTP-
Ascites | Jaundice | Hepatic
Encephalopathy
10/C
Comorbidities: Osteoporosis (T-score-3.8 at lumbar spine)
CURRENT ISSUES INICU:
1. Refractory Septic shock B/L Pneumonia Bacterial ( Klebsiella
Pneumonia ),Fungal -Respiratory Galactomanan-1.6
2. Encephalopathy ll Hepatic + Septic
3. Difficult to wean off Encephalitis likely Ischemic related
4. AKI-AKIN(HRS-AKI)
5. Urosepsis -(Urine c/s- Enterococcus-1000 cc)
6. Sub conjunctival hemorrhage
7. Sepsis and DIC related variceal bleed
8. Type Irespiratory failure.
PRESENTING COMPLAINTS
Altered sensorium x 1 day
INDICATION FOR ADMISSION:

For further evaluation and management.

HISTORY OF PRESENTING ILLNESS
PatientMr. Arun Kumar 43 years old male, chronic-alcoholic (L.I.- 3 vears) non
wi no h/o DM II, HTN, Thyroid disorders had
smoker, with his index
years ago in the
form of abdominal distension constipationwas
and presentation in 3
treatment from outside where he was taking
Conservative diagnosed as
last one year he had 4 episode of melena for which he underwentliverUGIEcirrhosis.
and In
Had h/oadmission
to ILBS with
endotherapy.
day anti HE measures given. In Jan 2024 he wascomplaint of altered
admitted with sensorium
greenish black since 1
Vomiting to ward for 2 days. Now, he has presented to ILBS with the above
 Death Summary
Patient Mr ARUN KUMAR UHID ILBS.0000310562
Age 43 Year(s) npatientNo IPID.0097688
Gender Male Mdmission Date 27 Jan 2024 09 22 AM
Ward Liver ICU Phase Il Discharge Date 14Feb 2024 01.38 PM
Speciality Hepatology Unit 2 Death Date 14Feb 2024 10.21 AM
Bed No 2369-19

mentioned complaints.There isno h/o jaundice,vomiting, cough, abdominal pain,

altered bowel habits, hematemesis, fever, constipation, burning micturition or
decreased urine output. There is no h/o any intoxications, indigenous medications,
major surgeries, blood transfusions or IV drug abuse prior to onset of the disease.
There is no h/o DM/HTN/CAD/TB/COPD/Thyroid disorder.
EXAMINATION AT THE TIME OF ADMISSION
Pt. was unconscious with poor GCS

BP:- 110/70 mm Hg, Pulse: - 75/min, RR: - 24/min andafebrile.

Pallort, Icterus+, Cyanosis-, Clubbing-, Pedal edema (pitting type) - , LNP-, JVP
normal

On systemic examination

Respiratory system: -B/L vesicular breathing, B/L decreased air entry.

Cardiovascular system:- S1 S2 normal, no murmurs

CNS: - Unconscious with Poor GCS

Per Abdomen examination

ON INSPECTION: - distended abdomen, umbilicus central and inverted, skin over the
abdomen is stretched with no visible venous prominences, no visible pulsations.

ON PALPATION: soft, non-tender, liver non- palpable. Spleen non- palpable. No

guarding, no rigidity, no rebound tenderness.

ON PERCUSSION: - dull note, free fluid present.

ON AUSCULTATION: - normal bowel sounds present, no bruits.

COURSE DURING HOSPITAL STAY:
Patient was admitted with above mentioned complaints. His
were as mentioned above. His initial lab data revealed examination findings
PT/INR-19.6/1.6, BU/S.Creat-14.4/0.6 with serum Na+/K+ Hb/TLC/PLT-12.0/5.4/98.
-128/4.5. LFT showed S.Bil
 Patient
Mr ARUN KUMAR Death Summary
Age: 43 Year(s)
Gender
UHID ILBS.0000310562
Ward
Male |npatientNo IPID 0097688
Liver ICU Phase || Admission Date 27 Jan 2024 09:22 AM
Speciality
llBed No Hepatology Unit 2 Discharge Date: 14 Feb 2024 01:38 PM
2369-19 Death Date 14Feb 2024 10:21 AM

(tPatient
-3.o0ta5/3.l/di3rect,ammonia-625.
/indirect):2.9/1.0/1.9, AST/ALT-83/43, SAP/GGTP-117/184,
and Alb/Glob

complaints. Urgent CCM

was
presented in emergency with above mentioned poor sensorium with?
review was taken and patient was sedated and intubated i/v/o attendants.
Metabolic Encephalopathy, after the informed consent frommanagement.
patient
Patient
From there patient shifted to LICU for
further evaluation and anti-fungals, IV fluids,
was started on with IV antibiotics, IV
aggressive management screening was done
anti-coma measures and other Supportive measures. Sepsis incubation. Urine
(urine c/s and blood c/s) showed no organism growth after 24h of
Sug-nil RBC2-4 L1-2 EpiCeliz
ouine microscopy iss/o ph-7.0 SpGr- 1.020 Alb-nil maintain MAP. Minibal curtu
Cast-nil. Patient was started on inotronic support to
was sent it showed Klebsiella pneumonia, for which
antibiotics were upgraded.
aggressive care was given for wnicn
Patient had severe hyper ammonia for which
Galactomannan-1.60. Ascitic fluid analySIs
regular ammonia monitoring was done, WBC/RBc/N/L/S/P/ALB/SAAG/ADA
done s/o so-Enterococcus
404/301887/82/17/122/1.89/1.3/1.91/5.0. Repeated Urine c/s
count. Need for LT has been explained in great detail, Prospective donor
1000 colony
shock with de-escalation of inotropes.
available. Patient had improvement of
sensorium of patient and to get a weaning
Sedation break was given to assess the brain was done, Multiple foci of
view of poor awakening MRI
trial however in matter regions
periventricular and deep white
T2/FLAIR hyper intensities in bilateral
ischemic changes ?Developmental venous anomaly with gliosis in right
likely sedated, and weaning was withheld. NCCT
temporal lobe. Thus current patient was ill-defined hypodensities seen in
Head--Subtle hyper dense focus with surrounding
suggestive of worsening pneumonia
right temporal lobe? Artifacts. Chest x-ray cultures were sent, and in view of
despite aggressive antibiotics, thus repeat sets of
Chest is being planned i.e. s/o
high Fio2 needs with worsening pneumonia, HRCT
Pilateral mild pleural effusion. Also relatives have been explained in great detail the
suggests any adverse
need for tracheostomy to prevent riskS of VAP, it the CT
Einding Regular CCM team done to ensure proper management. Chest and limb
buciotherapy done regularly. PRBCS were transtused i.v.o. anemia and correction
PROTEM based coagulopathy correction done. Incentive Spirometry done to
ensure proper lung volume. Hematoma developed on right side of abdomen for
hich coagulopathy correction done. Multiple PRBC transfusions were given to
maintain the Hb above 7. HPB Sx review was done iv.o LT and the need for LT as
definitive treatment has been explained and the donor workup till step -1 was done
(prospective donor- wife). ROTEM based coagulopathy correction was given. UGIE
ndoscopy was done i.V.o HD rall and 15 S/o Coagulopathy related bleed, Patient was
S t o maintain the blood OxYgen levels and he was put on HFNC. Later
patient
 Death Summary
LBS.0000310562
UHID |IPID.0097688
Mr ARUN KUMAR npatientNo
Patient 43 Year(s) Admission Date 27 Jan 2024 09:22 AM
Age Male Discharge Date. J14 Feb 2024 01.38 PM
Gender
Liver ICU Phase Il Death Date
14 Feb 2024 10:21AM
Ward: Hepatology Unit 2
Speciality:
2369-19
Bed No
from patients attendant and was put
informed consent
was intubated after taking sedated after informed consent of attendants
on
and
on mechanical ventilation anemia and correction done. The patients
12.02.24. PRBCS were transfused i.v.o
explained about the critical condition of the patient,
attendants have been
plan and guarded outcome of the disease in great detail.
management
Patients
shock kept worsening and he was put on triple inotropic support.
Patients Attendants were regularly explained
inotropic support gradually increased.
need for management plan and poor
about the critical clinical condition of the patient, Patient suddenly developed
prognosis along with the futility of the patient.
hypotension preceded by cardiac arrest on 14/2/24 at 09:50 AM .
bradycardia, resuscitation ROSE was absent,
Immediate CPR was started; despite of adequate
showed flat line and patient declared dead on 14/2/24 at 10:21 AM . Relatives
ECG
have been informed.

CAUSE OF DEATH:
Refractory septic shock
MODS with DIC

Advanced liver failure

Senior Resident:

Dr. Chandan Dr. Tushar Madhav Dr. Rahul

Dr. Hitesh Dr. Vishnu Girish Dr. Akhil
Dr. Priti Kumar Madke Khajuria
Singh 9532770958 8078120847 9420233292 7006871829
7280930234 7042745437 9645560617

Dr. Ibrar Ahmed Dr. Sudhir Kumar Dr. Jaifrin

Dr. Ravi Dr. Phool Chand Dr. Omkar S Rudra Dr. Avush Jain Verma Daniel
Nishad Khan
7006237152 8700060187 9140948873 9789230877
8384000528 9389532959 8178927317

Dr. Saurav Dr. Jaya Shree Dr Jitendra Kumar Dr shank Johri Dr. Garvit Dr. Shreyas Sarvesth Dr. Srajit Singh
Paul Biswas Singh Mundr
9771459220 9826274300
7005272192 8420417086 9661198656 9871028897 9706

Treating Faculty:
Dr. Shiv Kumar Dr Yogendra Kumar Dr. Vikram Dr Ankur Dr Shasthry S
Dr. Manoj Kumar Dr. Rakhi Maiwall M
Sarin Joshi Bhatia Jindal
Sr. Professor Professor Professor Addl. Professor
Addl. Addi. Professor
Sr. Consultant Professor

Dr Ashok Kumar Dr. Chitranshu Dr. Harsh Vardhan Dr. Babu Lal Dr. Satender
Choudhury Vashishtha Dr. Vinod Arora Dr, V Rajan Tevethia Meena Pal Singh
 Mr ARUN KUMAR
Death Summary ILBS.0000310562
Patient UHID
Age.: 43 Year(s) IPID.0097688
npatientNo AM
Gender Male |Admission Date |27 Jan 2024 0922 PM
01:38
Ward Liver ICUPhase ll
Discharge Date: |14 Feb 2024
10:21 AM
Speciality Hepatology Unit 2 Death Date: 14 Feb 2024
Bedd No 2369-19
INVESTIGATIONS: Reports enclosed
 Death Summary

EE
Patient
Age:
Mr ARUN KUMAR
43 Year(s)
UHID
npatientNo
ILBS.0000310562
PID.0097688
|Gender Male lAdmission Date 27 Jan 2024 09:22 AM
Ward Liver ICU Phase I| Discharge Date J14 Feb 2024 01.38 PM
Speciality Hepatology Unit 2 Death Date 14 Feb 2024 10:21 AM
Bed No 2369-19
Addl. Professor Associate Professor Associate Professor Associate Asst. Professor Asst. Asst. Professor
Professor Professor