fever projr -unclassified 45/M

 unclassified ; 

date of admission 29/2/2024 

date of discharge 11/3/2024

Diagnosis

ALTERED SENSORIUM SECONDARY TO CNS VASCULITIS WITH ACUTE ISCHEMIC STROKE: LEFT HEMIPARESIS [ACUTE INFARCT IN RIGHT LENTIFORM NUCLEUS AND SUBACUTE INFARCT IN DORSAL MIDBRAIN ON RIGHT SIDE]

? HERPES SIMPLEX VIRUS ENCEPHALITIS

ACTIVE PULMONARY TUBERCULOSIS [ATT STARTED ON 27/2/24 ]

PNEUMOCYSTITIS JIROVECI PNEUMONIA

HYPONATREMIA SECONDARY TO SIADH [RESOLVED]

? KORSAKOFF PSYCHOSIS

RVD + SINCE 2019

Case History and Clinical Findings

PATIENT WAS BROUGHT TO CASUALTY IN ALTERED MENTAL STATUS SINCE 12PM (21/02/2024).

HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC TILL 12PM THEN DEVELOPED ALTERED MENTAL STATUS ,SUDDEN IN ONSET ,INCOHERENT TO TIME,PLACE,PERSON

H/O HALLUCINATIONS SINCE 5 DAYS

H/O SLEEP DISTURBANCES SINCE 5 DAYS

H/O FEVER SINCE 15 DAYS, INTERMITTENT ,HIGH GRADE ASSOCIATED WITH CHILLS

H/O SLURRED SPEECH

H/O WEIGHT LOSS

NO H/O VOMITINGS , LOOSE STOOLS

NO H/O INVOLUNTARY MOVEMENTS,UPROLLING OF EYES,FROTH FROM MOUTH

NO H/O INVOLUNTARY MICTURITION ,DEFECATION

NO H/O COUGH,COLD

PAST HISTORY:

K/C/O RVD SINCE 2019 [ ON REGULAR MEDICATION ]

N/K/C/O HTN,DM ,CAD,CVA,EPILEPSY ,THYROID DISORDERS

GENERAL PHYSICAL EXAMINATION

VITALS AT ADIMISSION

TEMPERATURE:100.5 F

BP: 130/80MMHG

PR: 100BPM

RR:20CPM

GRBS - 134MG/DL

SPO2-98 % @ RA

CERVICAL LYMPHADENOPATHY +

CVS: S1,S2+

RS:BAE+

CNS:NFND

P/A :SOFT ,NT

PSYCHIATRY REFFERAL DONE ON 22/2/24 I/V/O ALTERED MENTAL STATUS,ADVICED TAB.CHLORDIAZEPOXIDE 25MG 0-0-1,NICOTINE GUMS PO SOS,THAIMINE SUPPLEMENTATION.

COURSE IN THE HOSPITAL:

DAY1:ADMISSION

PATIENT CAME TO THE HOSPITAL ON WEDNESDAY (21/02/2024) WITH C/O IRRELEVANT SPEECH AND ATAXIA

MRI WAS DONE

IMPRESSION: T2/FLAIR FOCAL HYPERINTENSITY IN DORSAL MIDBRAIN ON RIGHT SIDE WITH NO RESTRICTION OF DIFFUSION -MOSTLY NONSPECIFIC FINDING ,HOWEVER FOLLOWING DIFFERENTIALS CAN BE CONSIDERED

LATE ACUTE/EARLY SUBACUTE INFARCT IN DORSAL MIDBRAIN ON RIGHT SIDE

FOCAL DEMYELINATION

ATYPICAL WERNICK'S ENCEPHALOPATHY

CSF ANALYSIS FINDINGS ARE NORMAL

PATIENT TESTED HIV POSITIVE SINCE 2019 ,ON MEDICATIONS

DAY2:

PATIENT ORIENTED TO TIME,PLACE,PERSON WITH GCS E4V5M6

PSYCHIATRY REFERRAL DONE I/V/O DELIRIUM TREMENS AND KORSAKOFF PSYCHOSIS AND ADVICED WITH TAB.LIBRIUM 25MG

DAY3:

HRCT I/V/O RIGHT UPPER LOBE CONSOLIDATION

IMPRESSION- CONSOLIDATION WITH THIN WALLED CAVITY IN APICAL AND POSTERIOR SEGMENT OF RIGHT LUNG UPPER LOBE.

CENTRILOBULAR NODULES IN RIGHT LUNG UPPER LOBE.

SMALL NODULES SCATTERED IN REST OF THE LUNGS ON BOTH SIDES.

FNAC-LYMPHNODE LEFT CERVICAL NECK:

IMPRESSION- FEATURES SUGGESTIVE OF NECROTISING LYMPHADENITIS

DAY4:

SPUTUM FOR CULTURE AND SENSITIVITY

ZN STAIN- ACID FAST BACILLI SEEN.

DIRECT SMEAR- PLENTY OF PUS CELLS >25/CPF ,MODERATE EPITHELIAL CELLS 16- 18/LPF,MODERATE GRAM POSTIVE COCCI IN SINGLES,PAIRS,CHAINS FEW GRAM POSITIVE BACILLI,OCCASSIONAL GRAM POSTIVE BUDDING YEAST CELLS SEEN.

CULTURE REPORT- METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS GROWN.

BAL FOR CULTURE AND SENSITIVITY - PNEUMOCYSTIS JIROVECII ISOLATED

DAY5: PATIENT WAS DROWSY AT DAY TIME AND IRRITABLE AT NIGHT TIME,TAB.BACTRIM DS RT/QID STARTED

DAY6: PATIENT WAS DROWSY AND SWAYING TOWARDS LEFT SIDE AND WEAKNESS OF LOWER LIMB BUT ORIENTED TO TIME,PLACE,PERSON

STARTED ON ATT (TRUNAAT POSITIVE AND AFB POSITIVE) I.V.O PULMONARY TUBERCULOSIS

DAY7: AT 1PM WEAKNESS OF UPPER LIMBS AND LOWER LIMBS

AT 6PM PATIENT BECAME DROWSY AND GCS WAS LOW

MRI PLAIN : ACUTE INFARCT IN RIGHT LENTIFORM NUCLEUS .

DAPT+STATINS WERE STARTED ,STEROIDS WERE STARTED I.V.O CNS VASCULITIS

DAY8:

MRI PLAIN AND CONTRAST

IMPRESSION: K/C/O HIV POSITIVE

T2 FLAIR INTRAPARENCHYMAL HYPERINTENSITIES IN THE MEDIAL TEMPORAL LOBE AND POSTEROLATERAL ASPECT OF BRAIN STEM ON RIGHT SIDE

ON CONTRAST ADMINISTRATION ,THERE IS SIGNIFICANT RIGHT SIDED LEPTOMENINGEAL ENHANCEMENT IN THE BASAL CISTERNS ,MEDIAL TEMPORAL LOBE SYLVIAN FISSURE AND CEREBELLAR LEPTOMENINGES

ENHANCEMENT ALONG THE SURFACE OF CISTERNAL SEGMENT OF TRIGEMINAL NERVE

D/D'S :TUBERCULOUS MENINGITIS

HERPES SIMPLEX VIRUS MENINGOENCEPHALITIS

NEURO MELIODOSIS

SMALL ACUTE INFARCT IN RIGHT LENTIFORM NUCLEUS -VASCULITIC INFARCT

DILATED PERIOPTIC CSF SPACES -TO RULE OUT RAISED INTRA CRANIAL TENSION

ANTIVIRAL FOR HSV ENCEPHALITIS WERE STARTED

DAY 9 -

THE PATIENT WAS IN ALTERED SENSORIUM AND GCS- E3 V4M6 WITH CONTINUOUS HICCUPS AND OTHER INVESTIGATIONS NA- 121 AND 3% NACL @ 10 ML PER HOUR WAS STARTED AND TAB TOLVAPTAN 30 MG PO/OD I.V.O SIADH, TAB ITRACONAZOLE 200 MG BD WAS STARTED FOR ANTIFUNGAL COVERAGE [FUNGAL GROWTH INSPUTUM C/S ]

DAY-10 -19 -PATIENT WAS CONTINUED ON ALL SYMPTOMATIC AND SUPPORTIVE CARE [STEROIDS ,ATT,ART,ANTIVIRAL,DAPT,STATINS,ANTIEPILEPTICS]

PATIENT IMPROVED OVER DAYS AND DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION WITH ADVICE TO FOLLOW

VITALS AT ADIMISSION

TEMPERATURE:100.5 F

BP: 130/80MMHG

PR: 100BPM

RR:20CPM

GRBS - 134MG/DL

SPO2-98 % @ RA

PATIENT IS HEMODYNAMICALLY STABLE AT THE TIME OF DISCHARGE.

Investigation

HIV-POSITIVE

HBSAG-NEGATIVE

HCV-NEGATIVE

HEMOGRAM DONE ON 21/2/14

HB 9.6GM/DL

TLC 8700 CELLS/CUMM

PLATELET COUNT2.4 LAKHS/CUMM

NORMOCYTIC NORMOCHROMIC ANEMIA WITH RELATIVE NEUTROPHILIA

ESR -125MM

BLOOD UREA 21-02-2024M -15 mg/dl 42-12 mg/dl

SERUM CREATININE 21-02-2024 1.0 mg/dl 1.1-0.6 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 21-02-2024

SODIUM 130 mEq/L 145-136 mEq/L

POTASSIUM 3.9 mEq/L 5.1-3.5 mEq/L

CHLORIDE 98 mEq/L 98-107 mEq/L

LIVER FUNCTION TEST (LFT) 21-02-2024

Total Bilurubin 0.83 mg/dl 1-0 mg/dl

Direct Bilurubin 0.20 mg/dl 0.2-0.0 mg/dl

SGOT(AST) 27 IU/L 31-0 IU/L

SGPT(ALT) 43 IU/L 34-0 IU/L

ALKALINE PHOSPHATASE 127 IU/L 98-42 IU/L

TOTAL PROTEINS 7.7 gm/dl 8.3-6.4 gm/dl

ALBUMIN 3.1 gm/dl 5.2-3.5 gm/dl

A/G RATIO 0.67

RBS-121MG/DL 21/02/2024BLOOD GROUP-O POSITIVE

APTT -32 SEC

PT-16SEC

INR-1.11

BLOOD UREA -18MG/DL 23/02/2024

HEMOGRAM DONE ON 23/2/14

HB 10.8GM/DL

TLC 8000 CELLS/CUMM

PLATELET COUNT2.59 LAKHS/CUMM

NORMOCYTIC NORMOCHROMIC ANEMIA

SERUM CRETAININE -1.0MG/DL 23/02/2024

SERUM ELECTROLYTES (Na, K, C l) 23-02-2024

SODIUM 130 mEq/L 145-136 mEq/L

POTASSIUM 3.9 mEq/L 5.1-3.5 mEq/L

CHLORIDE 98 mEq/L 98-107 mEq/L

HEMOGRAM DONE ON 24/2/14

HB 10.9GM/DL

TLC 8700 CELLS/CUMM

PLATELET COUNT2.47LAKHS/CUMM

NORMOCYTIC NORMOCHROMIC ANEMIA

SERUM CRETAININE -1.0MG/DL 24/02/2024

SERUM ELECTROLYTES (Na, K, C l) 24-02-2024

SODIUM 131 mEq/L 145-136 mEq/L

POTASSIUM 3.7 mEq/L 5.1-3.5 mEq/L

CHLORIDE 99 mEq/L 98-107 mEq/L

BLOOD UREA -25MG/DL 24/02/2024

SERUM CRETAININE -1.1MG/DL 25/02/2024

SERUM ELECTROLYTES (Na, K, C l) 25-02-2024

SODIUM 135 mEq/L 145-136 mEq/L

POTASSIUM 4.1 mEq/L 5.1-3.5 mEq/L

CHLORIDE 99 mEq/L 98-107 mEq/L

HEMOGRAM DONE ON 26/2/14

HB 11.4GM/DL

TLC 8100 CELLS/CUMM

PLATELET COUNT2.24LAKHS/CUMM

NORMOCYTIC NORMOCHROMIC BLOOD PICTURE

SERUM ELECTROLYTES (Na, K, C l) 28-02-2024

SODIUM 135 mEq/L 145-136 mEq/L

POTASSIUM 3.8 mEq/L 5.1-3.5 mEq/L

CHLORIDE 98 mEq/L 98-107 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 28-02-2024

SODIUM 112 mEq/L 145-136 mEq/L

POTASSIUM 4.1 mEq/L 5.1-3.5 mEq/L

CHLORIDE 80 mEq/L 98-107 mEq/L

SERUM OSMOLALITY -228.2 29/02/2024

SERUM ELECTROLYTES (Na, K, C l) 29-02-2024

SODIUM 119 mEq/L 145-136 mEq/L

POTASSIUM 4.2 mEq/L 5.1-3.5 mEq/L

CHLORIDE 81 mEq/L 98-107 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 29-02-2024

SODIUM 132 mEq/L 145-136 mEq/L

POTASSIUM 4.0 mEq/L 5.1-3.5 mEq/L

CHLORIDE 94 mEq/L 98-107 mEq/L

SERUM CREATININE -0.9MG/DL 29/02/2024

SERUM ELECTROLYTES (Na, K, C l) 29-02-2024

SODIUM 131 mEq/L 145-136 mEq/L

POTASSIUM 3.7 mEq/L 5.1-3.5 mEq/L

CHLORIDE 98 mEq/L 98-107 mEq/L

MRI BRAIN PLAIN: 21/02/2024

IMPRESSION: T2/FLAIR FOCAL HYPERINTENSITY IN DORSAL MIDBRAIN ON RIGHT SIDE WITH NO RESTRICTION OF DIFFUSION -MOSTLY NONSPECIFIC FINDING ,HOWEVER FOLLOWING DIFFERENTIALS CAN BE CONSIDERED

LATE ACUTE/EARLY SUBACUTE INFARCT

FOCAL DEMYELINATION

ATYPICAL WERNICK'S ENCEPHALOPATHY

MRI BRAIN (PLAIN AND CONTRAST) :28/02/2024

IMPRESSION: K/C/O HIV POSITIVE

T2 FLAIR INTRAPARENCHYMAL HYPERINTENSITIES IN THE MEDIAL TEMPORAL LOBE AND POSTEROLATERAL ASPECT OF BRAIN STEM ON RIGHT SIDE

ON CONTRAST ADMINISTRATION ,THERE IS SIGNIFICANT RIGHT SIDED LEPTOMENINGEAL ENHANCEMENT IN THE BASAL CISTERNS ,MEDIAL TEMPORAL LOBE SYLVIAN FISSURE AND CEREBELLAR LEPTOMENINGES

ENHANCEMENT ALONG THE SURFACE OF CISTERNAL SEGMENT OF TRIGEMINAL NERVE

D/D'S :TUBERCULOUS MENINGITIS

HERPES SIMPLEX VIRUS MENINGOENCEPHALITIS

NEURO MELIOTOSIS

SMALL ACUTE INFARCT IN RIGHT LENTIFORM NUCLEUS -VASCULITIC INFARCT

DILATED PERIOPTIC CSF SPACES -TO RULE OUT RAISED INTRA CRANIAL TENSION

2D ECHO DONE ON 22/2/24

CONCLUSION:

NO MR/AR/TR

NO RWMA NO AS/MS SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION

NO PAH/RF.

CSF CULTURE AND SENSITIVITY:

NO BACTERIAL GROWTH IN 48HRS AEROBIC INCUBATION

SPUTUM FOR CULTURE AND SENSITIVITY

ZN STAIN- ACID FAST BACILLI SEEN.

DIRECT SMEAR- PLENTY OF PUS CELLS >25/CBF ,MODERATE EPITHELIAL CELLS 16- 18/LPF,MODERATE GRAM POSTIVE COCCI IN SINGLES,PAIRS,CHAINS FEW GRAM POSITIVE BACILLI,OCCASSIONAL GRAM POSTIVE BUDDING YEAST CELLS SEEN.

CULTURE REPRT- METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS GROWN.

FNAC-LYMPHNODE LEFT CERVICAL NECK:

IMPRESSION- FEATURES SUGGESTIVE OF NECROTISING LYMPHADENITIS

CEREBROSPINAL FLUID

MICROSCOPIC EXAMINATION - CYTO SMEAR STUDIES SHOWS FEW SCATTERED LYMPHOCYTES IN A CLEAR BACK GROUND.

HRCT CHEST ON 23/2/24

IMPRESSION- CONSOLIDATION WITH THIN WALLED CAVITY IN APICAL AND POSTERIOR SEGMENT OF RIGHT LUNG UPPER LOBE.

CENTRILOBULAR NODULES IN RIGHT LUNG UPPER LOBE.

SMALL NODULES SCATTERED IN REST OF THE LUNGS ON BOTH SIDES.

BAL FOR CULTURE AND SENSITIVITY

MICROSCOPIC EXAMINATION - CYTOSMEAR STUDIED SHOWS NUMEROUS CILIATED COLUMNAR CELLS [ BROCHIALWALL LINING CELLS ]IN CLUSTERS FEW SQUAMOUS CELLS ,DEGENRATED NEUTROPHILS,LYMPHOCYTES , IN THE BACKGROUND SHOWING MUCOID MATERIAL,HEMORRHAGE .

NO EVIDENCE OF ATYPICAL CELLS

GEIMSA STAIN - SHOWING ?CYSTS POSSIBLY PNEUMOCYSTIS JIROVECII CAN BE CONSIDERED

RFT 29-02-2024 11:42:PM

UREA 31 mg/dl 42-12 mg/dl

CREATININE 0.9 mg/dl 1.3-0.9 mg/dl

URIC ACID 8.9 mg/dl 7.2-3.5 mg/dl

CALCIUM 10.2 mg/dl 10.2-8.6 mg/dl

PHOSPHOROUS 4.4 mg/dl 4.5-2.5 mg/dl

SODIUM 121 mEq/L 145-136 mEq/L

POTASSIUM 4.3 mEq/L 5.1-3.5 mEq/L

CHLORIDE 90 mEq/L 98-107 mEq/L

LIVER FUNCTION TEST (LFT) 29-02-2024 11:42:PM

Total Bilurubin 1.10 mg/dl 1-0 mg/dl

Direct Bilurubin 0.18 mg/dl 0.2-0.0 mg/dl

SGOT(AST) 14 IU/L 35-0 IU/L

SGPT(ALT) 15 IU/L 45-0 IU/L

ALKALINE PHOSPHATASE 128 IU/L 128-53 IU/L

TOTAL PROTEINS 8.2 gm/dl 8.3-6.4 gm/dl

ALBUMIN 3.8 gm/dl 5.2-3.5 gm/dl

A/G RATIO 0.67

COMPLETE URINE EXAMINATION (CUE) 29-02-2024 11:42:PM

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN TRACE

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 2-3

EPITHELIAL CELLS 2-3

RED BLOOD CELLS Nil

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nil

SERUM ELECTROLYTES (Na, K, C l) 01-03-2024 07:54:PM

SODIUM 125 mEq/L 145-136 mEq/L

POTASSIUM 4.2 mEq/L 5.1-3.5 mEq/L

CHLORIDE 93 mEq/L 98-107 mEq/L

RFT 02-03-2024 04:15:AM

UREA 28 mg/dl 42-12 mg/dl

CREATININE 0.8 mg/dl 1.3-0.9 mg/dl

URIC ACID 8.0 mg/dl 7.2-3.5 mg/dl

CALCIUM 9.6 mg/dl 10.2-8.6 mg/dl

PHOSPHOROUS 4.6 mg/dl 4.5-2.5 mg/dl

SODIUM 126 mEq/L 145-136 mEq/L

POTASSIUM 4.0 mEq/L 5.1-3.5 mEq/L

CHLORIDE 92 mEq/L 98-107 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 02-03-2024 06:44:PM

SODIUM 130 mEq/L 145-136 mEq/L

POTASSIUM 4.2 mEq/L 5.1-3.5 mEq/L

CHLORIDE 94 mEq/L 98-107 mEq/L

COMPLETE BLOOD PICTURE (CBP) 03-03-2024 12:06:AM

HAEMOGLOBIN 10.8 gm/dl 17.0-13.0 gm/dl

TOTAL COUNT 10000 cells/cumm 10000-4000 cells/cumm

NEUTROPHILS 85 % 80-40 %

LYMPHOCYTES 10 % 40-20 %

EOSINOPHILS 01 % 6-1 %

MONOCYTES 04 % 10-2 %

BASOPHILS 00 % 2-0 %

PLATELET COUNT 3.06

SMEAR Normocytic normochromic with neutrophilia

SERUM ELECTROLYTES (Na, K, C l) 03-03-2024 12:06:AM

SODIUM 134 mEq/L 145-136 mEq/L

POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L

CHLORIDE 98 mEq/L 98-107 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 03-03-2024 03:14:PM

SODIUM 136 mEq/L 145-136 mEq/L

POTASSIUM 4.5 mEq/L 5.1-3.5 mEq/L

CHLORIDE 98 mEq/L 98-107 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 04-03-2024 12:04:AM

SODIUM 135 mEq/L 145-136 mEq/L

POTASSIUM 3.9 mEq/L 5.1-3.5 mEq/L

CHLORIDE 97 mEq/L 98-107 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 04-03-2024 05:06:PM

SODIUM 133 mEq/L 145-136 mEq/L

POTASSIUM 4.9 mEq/L 5.1-3.5 mEq/L

CHLORIDE 89 mEq/L 98-107 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 04-03-2024 10:16:PM

SODIUM 138 mEq/L 145-136 mEq/L

POTASSIUM 4.1 mEq/L 5.1-3.5 mEq/L

CHLORIDE 95 mEq/L 98-107 mEq/L

2D ECHO DONE ON 4/3/24

IMPRESSION- NO RWMA

MILD TR+, TRIVIAL AR+ , NO MR

NO AS/MS

IAS - INTACT

EF= 60 %

RVSP= 31+10= 41 MM HG

GOOD LV SYSTOLIC FUNCTION

NO DIASTOLIC DYSFUNCTION

NO PAH / PE

IVC SIZE- 1.01 CMS COLLAPSING.

LIVER FUNCTION TEST (LFT) 6-03-2024

Total Bilurubin 0.88 mg/dl

Direct Bilurubin 0.2 mg/dl

SGOT(AST) 28 IU/L

SGPT(ALT) 18 IU/L

ALKALINE PHOSPHATASE 127 IU/L

TOTAL PROTEINS 8.2 gm/dl

ALBUMIN 3.3 gm/dl

A/G RATIO 0.68

RFT 06-03-2024 9:18:AM

UREA - 41 MG/DL

CREATININE 0.9 MG/DL

URIC ACID 12.3 MG/DL

CALCIUM -10.1 MG/DL

PHOSPHOROUS - 4.8 MG/DL

SODIUM 136 mEq/L

POTASSIUM 4.6 mEq/L

CHLORIDE 98 mEq/L

SERUM ELECTROLYTES (Na, K, C l) 07-03-2024

SODIUM 133 mEq/L

POTASSIUM 4.2 mEq/L

CHLORIDE 98 mEq/L

COMPLETE BLOOD PICTURE (CBP) 07-03-2024

HAEMOGLOBIN 10.2 gm/dl

TOTAL COUNT 6,2000 cells/cumm

NEUTROPHILS 73 %

LYMPHOCYTES 21 %

EOSINOPHILS 00 %

MONOCYTES 06%

BASOPHILS 00 %

PLATELET COUNT 3.19

SMEAR Normocytic normochromic ANEMIA.

SERUM ELECTROLYTES (Na, K, C l) 10-03-2024

SODIUM 133 mEq/L 145-136 mEq/L

POTASSIUM 4.5 mEq/L 5.1-3.5 mEq/L

CHLORIDE 105 mEq/L 98-107 mEq/L

CALCIUM IONIZED 1.18 MMOL/L.

COMPLETE BLOOD PICTURE (CBP) 10-03-2024

HAEMOGLOBIN 11.0 gm/dl

TOTAL COUNT `10,900 cells/cumm

NEUTROPHILS 80%

LYMPHOCYTES 15 %

EOSINOPHILS 01 %

MONOCYTES 04%

BASOPHILS 00 %

PLATELET COUNT 3.09

SMEAR Normocytic normochromic .

USG ABDOMEN AND PELVIS -ON 10/3/24

BILATERAL GRADE I RPD CHANGES IN BOTH KIDNEYS

SERUM ELECTROLYTES (Na, K, C l) 11-03-2024

SODIUM 136mEq/L 145-136 mEq/L

POTASSIUM 4.0 mEq/L 5.1-3.5 mEq/L

CHLORIDE 99 mEq/L 98-107 mEq/L

CALCIUM IONIZED 1.20 MMOL/L.

COMPLETE BLOOD PICTURE (CBP) 11-03-2024

HAEMOGLOBIN 10.1 gm/dl

TOTAL COUNT `13,200 cells/cumm

NEUTROPHILS 85%

LYMPHOCYTES 11 %

EOSINOPHILS 01 %

MONOCYTES 03%

BASOPHILS 00 %

PLATELET COUNT 3.78

SMEAR Normocytic normochromic anemia with neutrophilic leucocytosis.

Treatment Given(Enter only Generic Name)

IVF NS @ 50ML/HR

RT FEEDS 100ML WATER 2ND HOURLY

200ML MILK WITH PROTEIN POWDER 4TH HOURLY

ORS SACHET IN 200ML WATER RT

INJ.ACYCLOVIR 500MG IV/TID FOR 7 DAYS F/B TAB .ACYCLOVIR 800MG PO TID X 5DAYS

INJ.LEVIPIL 500MG IV/BD

TAB.BACTRIM DS RT/QID 1-1-1-1 X 15 DAYS

TAB.TLD[300/300/50] PO/OD 0-0-1

TAB.DTG 50MG PO/OD 1-0-0

INJ.THIAMINE 200MG IN 100ML NS IV TID

INJ.DEXA 6 MG IV TID X 6 DAYS F/B TAB PREDNISOLONE 40 MG OD X 5 DAYS

INJ.PAN 40MG IV/OD

INJ.NEOMOL 1GM IV / SOS TEMP >101F

TAB.PCM 650MG PO/SOS

TAB.BENADON 40MG PO/OD 0-1-0

INJ.ZOFER 4MG IV/BD 1-0-1

TAB.BACLOFEN 10 MG PO TID

ATT 4FDC RT/OD BBF[ ISONIAZIDE/RIFAMPACIN/PYRIZINAMIDE/ETHAMBUTAL- 300MG/600MG/1600MG/100MG ]

TAB.ECOSPIRIN 150MG RT/HS

TAB.CLOPIDOGREL 75MG RT/HS

TAB.ATORVAS 40MG RT/HS

INJ.3% NACL 10 ML PER/HR GIVEN FOR 3 DAYS

TAB.TOLVAPTAN 30MG PO/OD

TAB.ITRACONAZOLE 200MG PO/BD X 10 DAYS

TAB STROCIT PLUS RT/BD

TAB MODAFINIL 200 MG RT/OD

OINT THROMBOPHOBE L/A

SYP MUCAINE GEL 10ML RT/TID

SYP DULCOLAX 15ML RT/HS

PHYSIOTHERAPY OF LEFT LOWER AND UPPER LIMBS

2ND HOURLY POSITION CHANGE

MONITOR VITALS INFORM SOS.

Advice at Discharge

ORS SACHET IN 200ML WATER 4TH HOURLY

TAB.BACTRIM DS RT/ QID 1-1-1-1 X 6 DAYS

TAB.ACYCLOVIR 800MG RT/ TID X 9 DAYS

TAB.TLD RT/ OD 0-0-1 X CONTINUE

TAB.DTG 50MG RT/ OD 1-0-0 X CONTINUE

TAB.BENFOMET PLUS RT/ OD X 15 DAYS

TAB PREDNISOLONE 40 MG RT/ OD AT 8 AM X 1 MONTH F/B TAPERING

TAB.PAN 40MG RT/ OD X 1 WEEK

TAB.PCM 650MG RT/ SOS

TAB.BENADON 40MG RT/ OD 0-1-0 X 6 MONTHS

ATT 4FDC RT/ OD BBF [ISONIAZIDE 300 MG + RIFAMPACIN 600MG +PYRIZINAMIDE 1600MG +ETHAMBUTAL 1100MG] X 6 MONTHS

TAB.ECOSPIRIN GOLD 75/75/20 MG RT/ OD HS X CONTINUE

TAB.TOLVAPTAN 30MG RT/ OD X 10 DAYS

TAB.ITRACONAZOLE 200MG RT/ BD X 4 DAYS

TAB STROCIT PLUS RT/ BD X 1 MONTH

TAB.MODAFINIL 100 MG AT 8 AM RT/ OD X 1 WEEK

SYP.DULCOLAX 15 ML RT/ HS AT 9 PM X 1 WEEK

SYP.MUCAINE GEL 10 ML RT/ TID X 1 WEEK

PHYSIOTHERAPY OF LEFT LOWER AND UPPER LIMBS

FOLEYS CARE