MEDICINE ELOGS

Monday, April 25, 2022

75Y/F WITH C/O SOB AND FEVER

CBBLE UDHC SIMILAR CASES

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT

PATIENT C/O SOB AND FEVER SINCE 3 DAYS

HOPI:

PT WAS AA 3 DAYS BACK THEN HE PRESENTED WITH SOB SINCE 3 DAYS [MMRC GR-II] , INCREASED ON EXERTION AND RELIEVED ON REST

NO ORTHOPNEA , NO PND AND NOT ASSOCIATED WITH WHEEZE

C/O FEVER SINCE 3 DAYS, LOW GRADE, INTERMITTENT AND NOT ASSOCIATED WITH CHILLS AND RIGOR , SWEATING AND NOT ASSOCIATED WITH DIURNAL VARIATION

LOSS OF APPETITE +

NO H/O COUGH,CHEST PAIN, CHEST TIGHTNESS ,HEMOPTYSIS,LOSS OF WEIGHT.

PAST H/O:

H/O SIMILAR COMPLAINTS IN THE PAST 2YRS AGO FOR WHICH SHE WAS ADMITTED AND POST DISCHARGE NEBULIZATION ,

K/C/O DM-2 SINCE 8Y AND ON MEDICATION

H/O BIOMASS EXPOSURE + FOR 40 YRS

NOT K/C/O HTN, BA,CAD,THYROID, TB.

NO H/O COVID

PERSONAL H/O:

HOMEMAKER BY OCCUPATION

DIET - MIXED,

APPETITE -DECREASED

BOWEL MOVEMENT - REGULAR

BLADDER MOVEMENTS - NORMAL

NO ADDICTIONS

NO KNOWN DRUG ALLERGIES

FAMILY HISTORY: NOT SIGNIFICANT

ON EXAMINATION

PATIENT IS CONSCIOUS , COHERENT, COOPERATIVE , THIN BUILT AND MODERATELY NOURISHED

NO SIGNS OF PALLOR ,ICTERUS, CLUBBING, CYANOSIS, LYMPHADENOPATHY, PEDAL EDEMA.

VITALS:

TEMP: AFEBRILE

PR: 110 BPM

BP:130/70 MMHG

SPO2: 84% ON RA

GRBS: 95mg%

RR: 25CPM

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD, NO MURMURS HEARD

PER ABDOMEN: SOFT, NONTENDER

CNS : NAD

RESPIRATORY SYSTEM :

INSPECTION: SHAPE OF THE CHEST- ELLIPTICAL

B/L SYMMETRICAL CHEST

TRACHEA APPEARS TO BE CENTRAL

EXPANSION OF CEHST : EQUAL ON BOTH SIDES

ACCESSORY MUSCLES REPIRATION +

NO DROPPNG OF SHOULDER

NO CROWDING OF RIBS

WASTING OF MUSCLES +

SPINOSCAPULAR DISTANCE EQUAL ON BOTH SIDES

PALPATION:

ALL INSPECTORY FINDINGS CONFIRMED

NO LOCLAL RISE OF TEMPERATURE

NO TENDERNESS

TRACHEA SLIGHTLY DVIATED TO RIGHT

CHEST MOVEMENTS EQUAL ON BOTH SIDES

AEPX BEAT @ LEFT 5TH ICS MEDIAL TO MIDCLAVICULAR LINE

TVF EQUAL IN BOTH AREAS

PERCUSSION:

DIRECT: RESONANT

INDIRECT:RESONANT

AUSCULTATION:

BAE+

VBS: HEARD

CREPTS + @ RIGHT INFRA SA , IAA

INVESTIGATIONS

2D ECHO

ECG

ROUTINE INVESTIGATIONS

FBS 83

PLBS

CXR

HRCT CHEST

HRCT

HRCt

Multiple focal area of bronchiectatic changes seen in both lung mainly in apical segment of left upper lobe ,right middle lobe ,lingular segment and left lower lobe with few area of mucoid impaction.

Multiple centrilobular nodules in both lung mainly in right middle lobe and left lower lobe.

Above features are suggestive of infective bronchiolitis likely secondary to Koch's disease.

DIAGNOSIS :- ACUTE EXACERBATION OF BRONCHIECTASIS WITH TYPE 2 DM

TREATMENT GIVEN :-

1]INJ.AUGMENTIN 1.2 G /IV/TID

2]INJ.PAN 40MG OD [BBF]

3]INJ.HYDROCORT 100MG IV OD

4]O2 INHALATION WITH NASAL PRONGS @ 2-3L/MIN

5]NEB BUDECORT TID ; MUCOMIST 4TH HRLY

6]T.MUCINAC LC/HS/TID

7]TAB.MONTAC LC HS/OD

8]SYP.ASCORIL 2 TSP TID X 1 WEEK

9]TAB.PCM 650MG SOS

60Y/M WITH C/O BREATHLESSNESS

CBBLE UDHC SIMILAR CASES

PATIENT C/O BREATHLESSNESS AND CHEST PAIN SINCE 4 DAYS , DRY COUGH SINCE 3 DAYS [OCCASSIONALLY].

HOPI:-

PT WAS APPARENTLY ASYMPTOMATIC 4 DAYS BACK THEN HE PRESENTED WITH BREATHLESSNESS WHICH IS SUDDEN IN ONSET[MMRC GR-III] ASSOCIATED WITH WHEEZE AND INCREASED ON LYING DOWN.

BREATHLESSNESS RELIEVED ON SITTING POSITION.

H/O COUGH + SINCE 3 DAYS , WITHOUT EXPECTORATION. DIURNAL VARIATION

CHEST PAIN SINCE 4 DAYS, NOT ASSOCITED WITH SWEATING, NONRADIATING. DRAGGING TYPE. NO POSTURAL VARIATION.

LOSS OF APPETITE +

NO H/O FEVER, CHEST TIGHTNESS , HEMOPTYSIS.

PAST H/O:

H/O SIMILAR COMPLAINTS IN THE PAST FOR WHICH HE USED ORAL MEDICATION AND INHALERS [ROTAHEALER WITH ROTACAP] FOR A WEEK.

H/O TB 20YRS BACK. USED ATT IRREGULARLY.

H/O ASTHMA 10 YRS BACK

NOT A K/C/O HTN ,DN,CAD

NO H/O COVID 19

DRUG H/O:

USED ATT 20 YRS BACK IRREGULARLY.

USED INJ.PIPTAZ BD FOR 5 DAYS

PERSONAL H/O:

MARRIED

DIET - MIXED,

APPETITE -DECREASED ,

BOWEL MOVEMENT - REGULAR

BLADDER MOVEMENTS - NORMAL

NO ADDICTIONS

NO KNOWN DRUG ALLERGIES

FAMILY HISTORY: NOT SIGNIFICANT

ON EXAMINATION

PEDAL EDEMA PRESENT

NO SIGNS OF PALLOR ,ICTERUS, CLUBBING, CYANOSIS, LYMPHADENOPATHY,

VITALS AT ADMISSION

TEMP: AFEBRILE

PR: 92 BPM

BP:100/70 MMHG

SPO2: 95% ON RA

GRBS: 110mg%

RR: 42CPM

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD, NO MURMURS HEARD

PER ABDOMEN: SOFT, NONTENDER

CNS : NAD

RESPIRATORY SYSTEM :

INSPECTION: SHAPE OF THE CHEST- ELLIPTICAL

TRACHEA APPEARS TO BE CENTRAL

RR 42 CPM

ACCESSORY MUSCLES REPIRATION +

NO DROPPING OF SHOULDER

SPINOSCAPULAR DISTANCE EQUAL ON BOTH SIDES

PALPATION:

ALL INSPECTORY FINDINGS CONFIRMED

NO LOCLAL RISE OF TEMP

NO TENDERNESS

TRACHEA CENTRAL IN POSITION

PERCUSSION:

DIRECT: RESONANT

INDIRECT:RESONANT

AUSCULTATION:

BAE+

VBS: HEARD

B/L RONCHI +

INVESTIGATIONS :-

ABG 22-04-2022 08:07:AM

PH 7.43

PCO2 42.2

PO2 75.4

HCO3 27.9

St.HCO3 27.7

BEB 3.8

BEecf 3.9

TCO2 56.3

O2 Sat 94.2

O2 Count 15.7

ABG 22-04-2022 06:01:PM

PH 7.43

PCO2 34.9

PO2 64.0

HCO3 23.1

St.HCO3 24.1

BEB -0.3

BEecf -0.6

TCO2 47.7

O2 Sat 91.9

O2 Count 13.1

ABG 22-04-2022 09:40:PM

PH 7.41

PCO2 39.3

PO2 65.9

HCO3 24.4

St.HCO3 24.7

BEB 0.4

BEecf 0.3

TCO2 51.3

O2 Sat 92.6

O2 Count 12.0

ABG 23-04-2022 03:25:PM

PH 7.32

PCO2 44.5

PO2 139

HCO3 22.5

St.HCO3 21.9

BEB -3.0

BEecf -2.6

TCO2 46.0

O2 Sat 97.4

O2 Count 17.3

ABG 24-04-2022 06:25:AM

PH 7.35

PCO2 39.3

PO2 83.5

HCO3 21.3

St.HCO3 21.6

BEB -3.4

BEecf -3.3

TCO2 45.2

O2 Sat 95.5

O2 Count 12.5

ABG 24-04-2022 07:17:PM

PH 7.37

PCO2 42.3

PO2 68.3

HCO3 24.0

St.HCO3 23.8

BEB -0.7

BEecf -0.5

TCO2 50.5

O2 Sat 93.8

O2 Count 12.7

ABG 25-04-2022 07:05:AM

PH 7.37

PCO2 44.8

PO2 61.7

HCO3 25.5

St.HCO3 24.8

BEB 0.6

BEecf 0.8

TCO2 53.3

O2 Sat 92.6

O2 Count 13.0

ABG 25/4/22 5PM

ABG 26/4/22 10AM

RFT 22-04-2022

UREA 35 mg/dl

CREATININE 1.0 mg/dl

URIC ACID 2.4 mg/dl

CALCIUM 10.0 mg/dl

PHOSPHOROUS 3.3 mg/dl

SODIUM 141 mEq/L

POTASSIUM 3.9 mEq/L

CHLORIDE 102 mEq/L

LIVER FUNCTION TEST (LFT) 22-04-2022

Total Bilurubin 0.65 mg/dl

Direct Bilurubin 0.20 mg/dl

SGOT(AST) 14 IU/L

SGPT(ALT) 11 IU/L

ALKALINE PHOSPHATE 101 IU/L

TOTAL PROTEINS 5.8 gm/dl

ALBUMIN 2.8 gm/dl

A/G RATIO 0.93

COMPLETE BLOOD PICTURE (CBP) 22-04-2022

HAEMOGLOBIN 11.0 gm/dl

TOTAL COUNT 10900 cells/cumm

NEUTROPHILS 76 %

LYMPHOCYTES 15 %

EOSINOPHILS 02 %

MONOCYTES 07 %

BASOPHILS 00 %

PLATELET COUNT 6.10

SMEAR Normocytic normochromic with thrombocytosis

HBsAg-RAPID Negative

Anti HCV Antibodies - RAPID Non Reactive

23-04-2022

SERUM CREATININE 1.0 mg/dl

SERUM ELECTROLYTES

SODIUM 146 mEq/L

POTASSIUM 3.5 mEq/L

CHLORIDE 103 mEq/L

COMPLETE BLOOD PICTURE (CBP)

HAEMOGLOBIN 8.7 gm/dl

TOTAL COUNT 10800 cells/cumm

NEUTROPHILS 89 %

LYMPHOCYTES 07 %

EOSINOPHILS 01 %

MONOCYTES 03 %

BASOPHILS 00 %

PLATELET COUNT 5.05

SMEAR Normocytic normochromic anemia with reactive neutrophilia

25/4/22

SERUM ELECTROLYTES (26-4-22):-

SODIUM 148 mEq/L

POTASSIUM 3.7 mEq/L

CHLORIDE 101 mEq/L

D DIMER 970 MCG/ML(22/4/22)

TROPONIN I: NEGATIVE

PT:16S

APTT:32S

INR:1.11

BT:2 MIN

CT: 4MIN 30SEC

CXR

2D ECHO

MIXED TR+ : TRIVIAL AR + ; NO MR

GOOD LV SYSTOLIC FUNCTION +

SCLEROTIC AV, NO MS/AS ; NO RWMA

DIASTOLIC DYSFUNCTION ; MILD PAH +

USG ABDOMEN

USG LEG

E/O DIFFUSE SUBCUTANEOUS EDEMA NOTED OVER ANKLE AND UPTO 5 CMS ABOVE TO IT

ATA , PTA AND DPA SHOWS MONOPHASIC WAVEFORM WITH DAMPENED FLOW.

ANTERIOR AND POSTERIOR TIBIAL VEINS ARE NORMAL

POPLITEAL ARETRY AND VEIN NORMAL

XRAY ANKLE AND KNEE RIGHT

ECG

SPUTUM C/S:-

TREATMENT GIVEN:-

1] IVF 1 NS @ 50ML/HR

2]INJ.PAN 40MG OD [BBF]

3]INJ.SLIDENAFIL 25MG BD

4]INJ.DERIPHYLLINE IV BD

5]INJ.HYDROCORT 100MG IV BD

6]INJ.PIPTAZ 4.5G IV TID

7]O2 INHALATION WITH NASAL PRONGS @ 2-3L/MIN

8]CPAP INTERMITTENTLY WITH SETTING

FIO2-30, PEEP-5

9]NEB DUOLIN QID ; BUDECORT TID ; MUCOMIST 4TH HRLY

10]TAB.MONTAC LC HS/OD

11]TAB AZEE 500MG PO OD

12]TAB.PCM 650MG SOS

Wednesday, March 16, 2022

40Y/M C/O INVOLUNTARY MOVEMENTS OF B/L UL AND LL

CBBLE UDHC SIMILAR CASES

Informant : Patients wife and son

A 40Y/M who is a farmer by occupation was brought to the casualty with c/o involuntary movements of B/L upper limbs and lower limbs ,GTCS type ,not associated with uprolling of eye, tongue bite, involuntary micturition/defecation.

3 episodes in a day,and was taken to a local hospital and was treated conservatively.

No similar complaints in the past

No c/o headache ,head trauma, Loc, chest pain, palpitations

Past history:-N/k/c/o Dm/htn/epilepsy/ CAD/Ba/thyroid disorders.

H/o jaundice 1 month ago for which he went to local practitioner.

Personal history:-

Married

Occupation: Farmer

Diet - Mixed,

Appetite -Normal ,

Bowel Movement - Regular

Bladder movements: Normal

No Known Drug Allergies

H/o alcohol consumption -Regularly 300ml since 20 yrs

H/o smoking since 20 years(3 packs/day)

No habit of other addictions

Family History: Not Significant

O/e:

Patient is conscious, coherent, cooperative

No signs of Pallor, icterus, Cyanosis, Clubbing, Lymphadenopathy,Pedal Edema

Temp:98.5°F

Pr:99bpm

Rr:18cpm

Bp:110/80

Spo2: 99% at RA

GRBS: 24mg/dl --> 25%D--> 264mg/dl

SYSTEMIC EXAMINATION

Cvs: S1 S2 +, no murmurs

Rs: BAE +,NVBS heard

PA: soft,non tender

CNS:-

Patient is conscious

Speech is normal

No signs of meningeal irritation

Crania nerves- NAD

Motor system: NAD

Sensory system: NAD

Gcs:- E6V2M6

- RIGHT LEFT

PUPIL. NSRL. NSRL

TONE UL NORMAL NORMAL

LL NORMAL NORMAL

POWER UL NORMAL NORMAL

LL NORMAL NORMAL

REFLEXES

a) BICEPS 2+ 2+

b) TRICEPS 2+ 2+

c) SUPINATOR 2+ 2+

d) KNEE 2+ 2+

e) ANKLE 2+ 2+

Provisional diagnosis:- Alcohol withdrawal seizures

INVESTIGATIONS:-

HEMOGRAM

HB: 7.6

TLC: 7,700

N/L/E/M/B: 78/16/00/06/00

PCV: 22.8

MCV: 102.7

MCH: 34.2

MCHC:33.3

RBC: 2.22

PLT: 1.40

RBC: 2.22

PS: NC/NC With mild thrombocytopenia

RFT:

BLOOD UREA : 5.3 MG/DL

SERUM CREATININE: 2.7

SERUM ELECTROLYTES:

Na+ : 139

K+: 3.4

Cl-: 101

Ca: 8.1

LFT

TB:0.56

DB: 0.17

SGOT:142

SGPT: 51

ALP: 190

TP: 4.7

ALBUMIN: 2.44

A/G: 1.08

SEROLOGY: NEGATIVE

RTPCR:- negative

FBS 122

HBA1C : 6.8%

ECG:

CXR

2D ECHO: https://youtu.be/wFy9kCgDhVY

EF: 55%

TRIVIAL TR+ / AR + / NO MR

NO RWMA , NO AS/MS, SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION +

NO DIASTOLIC DYSFUNCTION, NO PAH/PE

PLAN:-

1. 25% Dextrose IVF /IV/STAT

2. IVF 1 NS With 2 amp of thiamine/Iv/stat

3.IVF 5%Dextrose/Iv/Stat

4.IVF- NS, RL , DNS@ 100ML/HR

5.IVF 1 NS -2AMP of thiamine/IV/TID

6.Inj. pantop 40mg /iv/od

7. Inj.lorazepam 2cc/iv/SOS

8. Inform seizure activity

9.Monitor vitals hrly and grbs hrly

SOAP NOTES

DAY 1

AMC BED 3

S: no fever spikes

no fresh complaints

O/e

Patient is c/c/c

Temp:Afebrile

Pr:86bpm

Rr:19cpm

Bp:140/90

Spo2:94% at RA

Cvs: S1 S2 +, no murmurs

Rs: BAE +

PA: soft,non tender, Bs +

GRBS: 117mg/dl

A: ? Hypoglycaemic Seizures

(Whipples triad:

+ Symptoms of hypoglycemia

+ Resolution of symptoms after glucose

+ Low plasma glucose level )

1.IVF- NS, RL , DNS@ 75ML/HR

2. IVF 1 NS With 2 amp of thiamine/Iv/tid

3.Inj. pantop 40mg /iv/od

4.Inj. zofer 4mg /iv/sos

5.Tab. Librium 5mg/po/bd

6. Inform seizure activity

7.Monitor vitals hrly and grbs charting hrly

Plan for USG abdomen and psychiatry referral I/v/o alcohol dependence

CRP: NEGATIVE

ESR: 15MM

WARD UPDATE

DAY 2

S: no fever spikes

C/o pedal edema since yesterday night( pitting type)

O/e

Patient is c/c/c

Temp:Afebrile

Pr:92bpm

Rr:17cpm

Bp:110/80

Cvs: S1 S2 +, no murmurs

Rs: BAE +

PA: soft,non tender, Bs +

GRBS: 152mg/dl

A: Hypoglycaemic seizures

1.IVF- NS, RL , DNS@ 75ML/HR

2. IVF 1 NS With 2 amp of thiamine/Iv/tid

3.Inj. pantop 40mg /iv/od

4.Inj. zofer 4mg /iv/sos

5.Tab. Librium 25mg/po/bd

6. Inform seizure activity

7.Monitor vitals hrly and grbs charting 4th hrly

8.2 egg whites /day

9.2 tbsp of protein in 1 glass of water/milk /po/tid

Plan for usg abdomen i/v/o pain abdomen

Plan to discharge

Advice at discharge

1.Plenty of water

2.T.pan 40mg Po/OD/BF X 5D

3.T.MVT PO/OD X 2 WEEKS

45Y/F WITH C/O GENERALISED WEAKNESS SINCE 2 DAYS

CBBLE UDHC SIMILAR CASES

45 years old P3L3 female, agricultural labourer by occupation, came to the casuality with C/O generalised weakness since 2 days.

H/O vomitings and loose stools 2 days back.

HOPI:

Patient was apparently asymptomatic 1 year back and then had H/O Neck pain and backache - dragging type of pain, not associated with any numbness, tingling sensation of upper and lower limbs.

Patient started taking NSAID daily once for pain for 1 month, then she visited orthopaedician and advised her to get MRI: L-Spine and after that she was advised for surgery.

Patient had difficulty in passing stools (constipation) since 1 month for which the patient went to the nearby doctor 2 days back.

She was put on Syp. Lactulose and after 1 day, the patient had 5 episodes of watery stools for 1 day, 2 episodes of vomitings for 1 day which subsided now.

Generalised weakness present since 2 days.

PAST HISTORY:

Not a K/C/O DM/HTN/BA/TB/Epilepsy/Thyroid disorders/CAD/CVA

Patient underwent ECSL for Right Renal stones (ECSL) 6 years back, Hysterectomy 20 yrs back and Left Cataract Surgery 6 yrs back.

PERSONAL HISTORY:

Diet- mixed

Appetite- Normal

Sleep- Adequate

Bowel and bladder movements- Regular

No known allergies

No addictions

Family history: not significant

GENERAL EXAMINATION:

Patient is Conscious, coherent, cooperative.

No Pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema.

Vitals:

Temp.- Afebrile

BP- 110/70 mmHg

PR- 100 bpm

RR- 12 cpm

SpO2- 98%

GRBS- 138 mg/dL

SYSTEMIC EXAMINATION:

CVS- S1 S2 heard, no murmurs

RS- BAE+ NVBS+

P/A- Soft, Non-tender

CNS-

Patient is Lethargic

GCS- 15/15

Sensory and motor systems - Intact

Cranial nerves- intact

Reflexes- Intact

INVESTIGATIONS

USG ABDOMEN:

CHEST X-RAY PA VIEW:

X-RAY L-SPINE:

X-RAY L-SPINE Report :

C-Reactive protein: Positive on DOA:5 (2.4 mg/dL)

RFT on DAY 6

PROVISIONAL DIAGNOSIS:

AKI on CKD secondary to ?anagesic neuropathy

Pyrexia under evaluation

TREATMENT GIVEN:

1. IV Fluids NS and RL @ UO+50 ml/h

2. Inj. Optineuron 1 amp in 100 ml NS

3. Inj. PANTOP 40 mg IV OD

4. Inj. Lasix 20 mg IV BD (if sBP>110 mmHg)

5. Inj. Neomol 100 ml IV SOS (if temp>101 F)

6. Tab. PCM 500 mg PO SOS

7. GRBS - 6th hrly

8. I/O Charting

9. Monitor vitals 4th hrly

Orthopedics referral:

Nephrology Referral:

SOAP NOTES:

Day 2

Generalised weakness present

No fresh complaints

Temp.- Afebrile

BP- 120/70 mmHg

PR- 98 bpm

RR- 18 cpm

SpO2- 97% at RA

GRBS- 103 mg/dL

Viral Pyrexia with Thrombocytopenia

AKI secondary to ?Sepsis

1. IVF - NS,RL,DNS @ UO+100 ml/h

2. Inj. PANTOP 40 mg IV OD

3. Inj. Zofer 4 mg IV SOS

4. Inj. Lasix 40 mg IV BD (if sBP>110 mmHg)

5. Inj. Neomol 100 ml IV SOS (if temp>101 F)

6. Tab. PCM 500 mg PO/SOS

7. Tab. Doxycycline 100 mg PO/BD

8. Monitor vitals 4th hrly

9. I/O and Temp. Charting

Day 3

C/o burning micturition, nausea (+), decreased appetite,

No h/o fever, vomitings

Pt is C/C/C

Temp- afebrile

Bp- 120/70 mmhg

PR- 74bpm

RR- 16cpm

SPO2- 99%

CVS- S1 S2 heard

Rs- BAE+

CNS- NFND

P/A- Soft, Non-tender

Viral pyrexia with thrombocytopenia

AKI secondary to ?GE

With UTI secondary with R renal calculi

1. IVF- NS RL DNS UO+ 50ml/hr

2. Inj. Optineuron 1amp in 100ml NS IV/OD

3. Inj. Pantop 40mg IV OD

4. Inj. Zofer 4mg IV OD

5. Inj. Neomol 1amp in 100ml NS IV if temp >101F

6. T. PCM 500mg PO/SOS

7. Temperature and I/O charting

8. Vitals monitoring

Day 4

C/o burning micturition, nausea (+) decreased appetite,

No h/o fever, vomitings

Pt is C/C/C

Temp- afebrile

Bp- 110/70 mmhg

PR- 72 bpm

RR- 17 cpm

SPO2- 98%

CVS- S1 S2 heard

RS- BAE+

CNS- NFND

P/A- Soft, Non-tender

Viral pyrexia with thrombocytopenia

AKI secondary to ?GE

With UTI secondary with R renal calculi

1. IVF- NS RL DNS UO+ 50ml/hr

2. Inj. Optineuron 1amp in 100ml NS IV/OD

3. Inj. Pantop 40mg IV OD

4. Inj. Zofer 4mg IV OD

5. Inj. Neomol 1amp in 100ml NS IV if temp >101F

6. T. PCM 500mg PO/SOS

7. Temperature and I/O charting

8. Vitals monitoring

Day 5

C/O decreased appetite and nausea+

No fever spikes

Pt is C/C/C

Temp- Afebrile

Bp- 110/80 mmhg

PR- 82 bpm

RR- 18 cpm

SPO2- 99%

CVS- S1 S2 heard

RS - BAE+

CNS- NFND

P/A- Soft, Non-tender

Viral pyrexia with thrombocytopenia

AKI secondary to ?GE

With UTI secondary with R renal calculi

1. IVF- NS RL DNS UO+ 50ml/hr

2. Inj. Optineuron 1amp in 100ml NS IV/OD

3. Inj. Pantop 40mg IV OD

4. Inj. Zofer 4mg IV OD

5. Inj. Neomol 1amp in 100ml NS IV if temp >101F

6. Inj. Lasix 40 mg IV BD if sBP>110 mmHg

7. T. PCM 500mg PO/SOS

8. T. Doxycycline 100 mg PO/BD

9. Syp. Lactulose 15 ml PO/HS

10. Syp. Aristroxyme 15 ml PO/TID

11. Syp.Cremaffin 5ml PO/TID HS

12. Temperature and I/O charting

13. Vitals monitoring

14. GRBS monitoring 12 th hrly