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23 year old female completed degree and is taking police training since 1year, came with c/o fever since 5days
Patient was apparently asymptomatic 5days back, c/o fever since 5days, rise of temperature in the afternoon and night time. Rise of temperature associated with chills and rigors followed by profuse sweating and fall of temperature,associated with generalised body pains.
Outside report 4days back showed smear for MP positive and she was put on T. Monocef and T. PCM. 4 days back she had 2episodes of vomiting, food as content and 2episodes of vomiting 2days back food as content.
C/o 1episode of black coloured stool 3days back
No h/o rashes, cold, cough, SOB,loose stools
H/o dengue 1year back for which she was admitted and managed medically
H/o chicken pox 5months back, did not use any medications, subsided in 9days spontaneously
Not a k/c/o DM, HTN, CAD, CVA, TB, asthma, epilepsy
Menstrual history: 5/35,normal flow, no clots, dysmenorrhoea,LMP:9/9/20
O/E:pt c/c
Pallor+ , icterus -ve , clubbing -ve , cyanosis -ve , koilonychia -ve , bilateral sub mandibular non tender lymph nodes palpable , no edema
Temp:101.5 - 99.5F.
PR:120/min,BP:100/80mmhg,RR:22cycles/min
SpO2:97% on RA
GRBS:101mg/dl
Cvs:S1 s2+, no murmurs
RS:BAE+, NVBS
P/A:soft, non tender, no organomegaly
CNS:no FND
Fever under evaluation (? Clinical malaria)
Anemia under evaluation
Hypoalbuminemia
Hb:7.9gm/dl
TLC:6,000cells/cumm
plt:1.8lak/cumm
MCV:65.3 fl
MCH:22.3 pg
MCHC:34.2%
PCV:1.8 vol%
Microcytic,hypochromic with anisopoikilocytosis tear drop cells and pencil forms present
Outside report USG abdomen:right Renal caliculi(2.3,2.8mm without HUN)
RFT
Urea:27mg/dl
Creat:0.9mg/dl
Uric acid:3.0mg/dl
Ca+:9.9 mg/dl
Po4-:1.9 mg/dl
Na:134 meq/l
K:4.4 meq/l
Cl:101 meq/l
MP:strip negative
Smear negative
LFT:
TB 1.2mg/dl
DB 0.34mg/dl
Sgot 119 IU/L
Sgpt 139 IU/L
Alp 224 IU / L
Alb 2.7 gm/dl
Dengue
NS1:negative
IgG:negative
IgM:negative
CUE alb 1+,pus cells:3-4,rbc:3-4
Day 1:-
OE pt c/c
Temp:104F at 10 30 am(T. PCM 650mg given, ice packs, tepid sponging done)
BP 110/70mmhg
PR:102/min
Spo2:94%on RA
Cvs:s1 s2+
Rs:BAE+, NVBS
P/A soft, non tender
CNS :no FND
Rectic count:2.1%
Corrected retic count :1%
RPI:0.5
S/o hypoproliferative anemia
Serum iron:50mcg/dl
Serum ferritin - 203.7ng/dl
CBP today:
Hb 7.5 gm/dl
TLC 5,600 cells /cumm
Plt 1.5L/cumm
X ray :-
Day 2:-
COMPLAINTS OF FEVER SPIKES,DRY COUGH,AND SHORTNESS OF BREATH AND DID NOT PASS STOOLS SINCE YESTERDAY.
TEMP 104F.
O/e - inspection normal
Palpation Normal
Percussion - dull notes present in
Right Left
Infrascapular area. Infrascapular area
Infra auxiliary area
Rt >lt
Auscultation -
Right Left
Vocal fremitus decreased in rt infrascapular area. Lt suprascapular area
Whispering pectoriloquy in rt infrascapular area. Lt suprascapular area
Bronchophony in lt suprascapular area
SHE WAS GIVEN
TAB PCM 650MG,
INJNEOMOL 100IV,
INJ CEFTRIAXONE 1GM /IV BD, and
FIRST DOSE OF INJ FALCIGO 120MG/IV STAT WAS GIVEN.
IN VIEW OF FALL INSATURATION OF 88% ON ROOM AIR, SHE WAS PUT ON 4-6 LITRES OXYGEN.IV FLUIDSWERE GIVEN.
Day 3:-
COMPLAINTS OF FEVER SPIKES, COUGH AND SHORTNESS OF BREATH.
O/e - inspection normal
Palpation Normal
Percussion - dull notes present in
Right. Left
Infrascapular area. Infrascapular area
Infra auxiliary area
Rt >lt
Auscultation -
Right Left
Vocal fremitus decreased in rt infrascapular area. Lt suprascapular area
Whispering pectoriloquy in rt infrascapular area. Lt suprascapular area
Bronchophony in lt suprascapular area
ABG
PH - 7.46
PCO2 - 26.6 mmhg
PO2 - 67.4 mmhg
HCO3 - 18.7 mmol/l
St.HCO320.9 mmol/l
BEB-4.0 mmol/l
BEecf-4.5 mmol/l
TCO2 - 39.2
O2 Sat - 86.1%
O2 Count - 10.4
TEMP -100F.
X ray :
DECREASED BREATH SOUNDS IN RIGHT ISA,IAA AND LEFT ISA.
INJ NEOMAL GIVEN.
INJCEFTRIAXONE 1GM/IV AND
TAB ZINCOVIT OD AND
TAB LIMCEE WAS GIVEN.
SECOND DOSE OF INJ FALCIGO 120MG/IV STAT GIVEN.
His peripheral smear
