Fever projr dengue 202407401

 Diagnosis

DENGUE PYREXIA (NS POSITIVE)

CHRONIC KIDNEY DISEASE ON MAINTENANCE HEMODIALYSIS

Case History and Clinical Findings

PATIENT CAME WITH C/O FEVER SINCE 3DAYS, CHEST PAIN SINCE TODAY MORNING

HOPI-

PT WAS APPARENTLY ASYMPTOMATIC TILL TODY MORNING THEN SHE DVELOPED CHEST PAIN WHICH IS SUDDEN IN ONSET, GRADUALLY PROGRESSIVE(BURNING TYPE, LOCALISED, LEFT SIDED) ASSOCIATED WITH SOB GRADE III

C/O PEDAL EDEMA, BILATERAL PITTING TYPE, GRADE II

H/O FEVER 3 DAYS AGO WITH GENERALISED BODY PAINS TESTED NS POSITIVE 3 DAYS AGO WITH YESTERDAY PLATELETS 65OOO

NO C/O BURNING MICTURITION, VOMITINGS, LOOSE STOOLS, BLEEDING GUMS, HEMATEMESIS, HEMOPTYSIS, PURPURA, RASHES, PALPITATIONS.

PAST HISTORY-

H/O LEFT PCNL + DJ STENTING DONE 3 MONTHS AGO WITH STENT REMOVAL DONE LEFT MULTIPLE CALCULI , B/L HUN WAS PRESENT L>R

K/C/O CKD SINCE 3 MONTHS ON DIALYSIS SINCE 20 DAYS ,8 HD DONE.

NOT A K/C/O DM, HTN, CAD,CVA, ASTHMA, THYROID DISORDERS.

FAMILY HISTORY- INSIGNIFICANT

MENTRUAL HISTORY- MENOPAUSE ATTAINED 20 YRS AGO

GENERAL EXAMINATION

PT IS C/C/C

NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA.

PR- 96 BPM

BP- 110/80 MMHG

AFEBRILE

RR- 24CPM

SP02- 97 %

SYSTEMIC EXAMINATION-

CVS- S1 S2+, NO MURMURS

CNS- HIGHER MENTAL FUNCTIONS INTACT , GCS 15/15 E4 V5 M6

RS- BAE+, NVBS

PA- SOFT, NON TENDER

Investigation

HBsAg-RAPID 15-02-2024 10:39:AM Negative

Anti HCV Antibodies - RAPID 15-02-2024 10:39:AM Non Reactive

BLOOD UREA 15-02-2024 10:39:AM 48 mg/dl

SERUM CREATININE 15-02-2024 10:39:AM 5.8 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 15-02-2024 10:39:AM

SODIUM 127 mEq/L

POTASSIUM 3.2 mEq/L

CHLORIDE 99 mEq/L

CALCIUM IONIZED 1.07 mmol/L

BLOOD UREA 15-02-2024 11:21:PM 98 mg/dl

SERUM CREATININE 15-02-2024 11:21:PM 6.3 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 15-02-2024 11:21:PM

SODIUM 130 mEq/L

POTASSIUM 3.1 mEq/L

CHLORIDE 95 mEq/L

CALCIUM IONIZED 1.11 mmol/L

BLOOD UREA 17-02-2024 12:07:AM 154 mg/dl

SERUM CREATININE 17-02-2024 12:07:AM 6.5 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 17-02-2024 12:07:AM

SODIUM 130 mEq/L

POTASSIUM 3.0 mEq/L

CHLORIDE 97 mEq/L

CALCIUM IONIZED 1.03 mmol/L

ABG 17-02-2024 12:20:AM

PH 7.40

PCO2 22.1

PO2 120

HCO3 13.5

St.HCO3 15.9

BEB -10.4

BEecf -10.4

TCO2 29.8

O2 Sat 97.9

O2 Count 7.3

HEMOGRAM ON 18/2/24

HB-8.5

TLC-11400

N/L/M/E/B- 78/15/7/0/0

PLT-83000

NORMOCYTIC NORMOCHROMIC ANEMIA WITH THROMBOCYTOPENIA

SERUM ELECTROLYTES

NA-134

K-3.2

CL-99

CA-1.13

CREAT-4.7

UREA-112

PT-20 SEC

INR-1.4

APTT-41 SEC

USG ABDOMEN AND PELVIS

IMPRESSION- B/L MEDULLARY NEPHROCALCINOSIS

EXTENSIVE GALL BLADDER WALL EDEMA

MILD ASCITIS( PERIHEPATIC ,INTERBOWEL)

B/L GRADE III RPD CHANGES

? PERIPORTAL EDEMA

RIGHT PLEURAL EFFUSION

MINIMAL ANTERIOR ABDOMINAL WALL EDEMA

FEW VISUALISED SMALL BOWEL WALL EDEMA

2D ECHO-

NO RWMA, MILD LVH (1.25 CM)

MILD AR, TRIVIAL; TR, TRIVIAL MR

SCLEROTIC AV, NO AS/MS

IAS INTACT

EF- 66% , RVSP -22+10= 32 MMHG

GOOD LV SYSTOLIC FUNCTION

NO DIASTOLIC DYSFUNCTION

MINIMAL PE+ , NO PAH

IVC SIZE 0.5 CM , COLLAPSING

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION <1.5 L/DAY

SALT RESTRICTION <2 G/DAY

TAB. DOXY 100MG PO/BD

TAB. OROFER XT PO/OD

TAB. NODOSIS 1000 MG PO/BD

TAB. PCM 650 MG PO/QID

TAB. LASIX 40 MG BD

TBA. SHELCAL CT PO/BD

TAB. NEPHROSAFE PO/OD

INJ. PAN 80 MG IN 100ML NS IV/STAT

TAB. SPOROLAC DS PO/TID

CAP. REPOTIL PO/BD

INTRADIALYSIS 1 PRBC, 1 SDP TRANSFUSED

Advice at Discharge

FLUID RESTRICTION <1.5 L/DAY

SALT RESTRICTION <2 G/DAY

TAB. DOXY 100MG PO/BD

TAB. OROFER XT PO/OD

TAB. NODOSIS 1000 MG PO/BD

TAB. PCM 650 MG PO/QID

TAB. LASIX 40 MG BD

TBA. SHELCAL CT PO/BD

TAB. NEPHROSAFE PO/OD

TAB. SPOROLAC DS PO/TID

CAP. REPOTIL PO/BD


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