feverprojr - malaria 65/F

MALARIA - 

date of admission 12/5/2024 

date of discharge 27/5/2024



Diagnosis

ATRIAL FIBRILLATION WITH MODERATE MR

HEART FAILURE WITH PRESERVED EJECTION FRACTION (EF-54%)

?CLINICAL MALARIA

?MESENTERIC ISCHAEMIA

K/C/O HTN SINCE 2 YRS

Case History and Clinical Findings

C/O FEVER SINCE 10 DAYS

C/O SOB SINCE 5 DAYS

HOPI :

PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK THEN SHE DEVELOPED FEVER HIGH GRADE A/W CHILLS AND RIGORS CONTINUOUS , RELIEVED WITH MEDICATION DIURNAL VARIATION,MORE DURING NIGHT .

THEN SHE HAD SOB GRADE 1,INSIDIOUS IN ONSET AND PROGRESSED GRADEUALLY TO GRADE 4

H/O PALPITATIONS , OCCASIONAL CHEST PAIN,+

H/O COUGH,NON PRODUCTIVE SINCE 5 DAYS

NO H/O HEMATURIA ,BURNING MICTURITION

H/O ABDOMINAL BLOATING SENSATION

NO H/O PAIN ABDOMEN,CONSTIPATION,LOOSE STOOLS

NO H/O DECREASED URINE OUTPUT , FACIAL PUFFINESS

H/O PEDAL EDEMA +


PAST HISTORY :

K/C/O HTN SINCE 2 YRS AND ON T.AMLODIPINE AT 5/50

N/K/C/O DM,CAD,CVA,TB,SEIZURES,ASTHMA,THYROID

PERSONAL HISTORY :

DAILY WAGE WORKER BY OCCUPATION

APPETITE - NORMAL , MIXED DIET , REGULAR BOWEL &BLADDER ,OCCASIONAL TODDY INTAKE SINCE 40 YRS &BETEL LEAF INTAKE HISTORY +

GENERAL EXAMINATION: PATIENT IS CONSCIOUS,COHERENT COOPERATIVE WELL ORIENTED TO TIME PLACE AND PERSON

CYANOSIS + OVER LIPS

NO PALLOR,ICTERUS,CLUBBING,LYMPHADENOPATHY

TEMPERATURE-98.6 F

PULSE RATE-126 BPM

RESPIRATORY RATE-24 CPM

BP-140/90 MG HG

SPO2 95%@RA

GRBS-140 MG/DL

SYSTEMIC EXAMINATION:

CVS-S1S2+, NO MURMURS

RS-BAE+,NVBS+, B/L FINE INSPIRATORY CREPTS +

PER ABDOMEN- , SOFT, NON TENDER, NO ORGANOMEGALY

CNS- CONSCIOUS, PUPILS-NSRL

GCS-15/15 E4V5M6

TONE RIGHT LEFT

UL NORMAL NORMAL

LL NORMAL NORMAL

POWER RIGHT LEFT

UL 5/5 5/5

LL 5/5 5/5

REFLEXES BICEPS TRICEPS SUPINATOR KNEE ANKLE

RIGHT 2+ 2+ - 2+ -

LEFT 2+ 2+ - 2+ -

PLANTAR RESPONSE-

RIGHT-FLEXOR 


LEFT-FLEXOR

FINGER NOSE AND KNEE HEEL INCOORDINATION: NO

SURGERY REFERRAL WAS DONE ON 15/5/24 I/V/O OBSTIPATION AND DIFFUSE ABDOMINAL TENDERNESS

ADVISE : HIGH FIBRE DIET , PLENTY OF ORAL FLUIDS, DULCOLEX SUPPOSITORIES

CARDIOLOGY REFERRAL DONE ON 23/5/24 I/V/O SHORTNESS OF BREATH

ADVISED: INJ.LASIX, HEPARIN BRIDGING,TAB.ECOSPIRIN 75 MG,TAB.DILTIAZEM

Investigation

HBsAg-RAPID 12-05-2024 11:09:PM Negative

Anti HCV Antibodies - RAPID 12-05-2024 11:09:PM Non ReactiveCOMPLETE URINE EXAMINATION (CUE) 12-05-2024 11:09:PMCOLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN +SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3- 4EPITHELIAL CELLS 2-3RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil

RFT 12-05-2024 11:09:PMUREA 49 mg/dl CREATININE 2.24 mg/dl URIC ACID 7.04 mmol/L CALCIUM 10.2 mg/dl PHOSPHOROUS 3.44 mg/dl SODIUM 136 mmol/L POTASSIUM 4.9 mmol/L. .CHLORIDE 104 mmol/L ABG 12-05-2024 11:09:PMPH 7.40PCO2 24.6PO2 81.1HCO3 15.3St.HCO3 18.5BEB -7.4BEecf -8.5TCO2 30.3O2 Sat 96.4O2 Count 18.1

LIVER FUNCTION TEST (LFT) 12-05-2024 11:09:PMTotal Bilurubin 1.05 mg/dl Direct Bilurubin 0.39 mg/dl SGOT(AST) 60 IU/L SGPT(ALT) 80 IU/L ALKALINE PHOSPHATASE 180 IU/L TOTAL PROTEINS 7.8 gm/dl ALBUMIN 2.8 gm/dl A/G RATIO 1.0RFT 13-05-2024 01:58:AMUREA 50 mg/dl CREATININE 2.35 mg/dl URIC ACID 7.51 mmol/L CALCIUM 10.2 mg/dl PHOSPHOROUS 3.06 mg/dl SODIUM 136 mmol/L POTASSIUM 4.9 mmol/L. CHLORIDE 104 mmol/L

T3, T4, TSH 13-05-2024 02:15:PMT3 0.89 ng/ml T4 9.46 micro g/dl TSH 1.15 micro Iu/mlRFT 13-05- 2024 10:35:PMUREA 46 mg/dl CREATININE 2.3 mg/dl URIC ACID 8.9 mmol/LCALCIUM 10.2 mg/dl PHOSPHOROUS 4.7 mg/dl SODIUM 134 mmol/LPOTASSIUM 5.2 mmol/L.CHLORIDE 104 mmol/L

SERUM ELECTROLYTES (Na, K, C l) 14-05-2024 03:58:PMSODIUM 132 mmol/L POTASSIUM 4.8 mmol/L CHLORIDE 103 mmol/L SERUM ELECTROLYTES (Na, K, C l) 14-05-2024 09:40:PMSODIUM 134 mmol/L POTASSIUM 4.4 mmol/L CHLORIDE 103 mmol/L

SERUM ELECTROLYTES (Na, K, C l) 15-05-2024 12:19:AMSODIUM 134 mmol/L POTASSIUM 4.5 mmol/L CHLORIDE 104 mmol/LCOMPLETE URINE EXAMINATION (CUE) 15-05-2024 03:13:PMCOLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN +SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4EPITHELIAL CELLS 2-3RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil


STOOL FOR OCCULT BLOOD 15-05-2024 03:13:PM positive (+ve)RFT 15-05-2024 09:46:PMUREA 57 mg/dl CREATININE 1.5 mg/dl URIC ACID 5.6 mmol/LCALCIUM 9.7 mg/dl PHOSPHOROUS 4.6 mg/dl SODIUM 132 mmol/L POTASSIUM 4.8 mmol/L. CHLORIDE 99 mmol/L

LIVER FUNCTION TEST (LFT) 15-05-2024 11:09:PMTotal Bilurubin 1.24 mg/dlDirect Bilurubin 0.20 mg/dl SGOT(AST) 18 IU/LSGPT(ALT) 23 IU/L ALKALINE PHOSPHATASE 126 IU/L TOTAL PROTEINS 6.9 gm/dl ALBUMIN 2.5 gm/dl A/G RATIO 0.56RFT 16-05-2024 10:39:PMUREA 57 mg/dl CREATININE 1.7 mg/dl URIC ACID 5.6 mmol/L CALCIUM 9.7 mg/dl PHOSPHOROUS 6.4 mg/dl SODIUM 133 mmol/L POTASSIUM 4.7 mmol/L. CHLORIDE 103 mmol/L

SERUM AMYLASE 17-05-2024 06:09:AM 36 IU/L 140-25 IU/LLIVER FUNCTION TEST (LFT) 17-05- 2024 06:09:AMTotal Bilurubin 1.46 mg/dl Direct Bilurubin 0.38 mg/dlSGOT(AST) 20 IU/LSGPT(ALT) 22 IU/LALKALINE PHOSPHATASE 131 IU/L TOTAL PROTEINS 7.4 gm/dl ALBUMIN 2.5 gm/dl A/G RATIO 0.51

RFT 17-05-2024 10:02:PMUREA 59 mg/dlCREATININE 1.7 mg/dl URIC ACID 5.7 mmol/L CALCIUM 10.0 mg/dl PHOSPHOROUS 5.8 mg/dl SODIUM 132 mmol/L POTASSIUM 4.3 mmol/L. CHLORIDE 103 mmol/L COMPLETE URINE EXAMINATION (CUE) 18-05-2024 10:50:PMCOLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN NilSUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-3EPITHELIAL CELLS 2-3RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil

RFT 19-05-2024 09:57:AMUREA 65 mg/dl CREATININE 1.9 mg/dl URIC ACID 5.4 mmol/L CALCIUM 9.6 mg/dl PHOSPHOROUS 5.7 mg/dl SODIUM 136 mmol/L POTASSIUM 4.2 mmol/L. CHLORIDE 99 mmol/L RFT 19-05-2024 10:35:PMUREA 71 mg/dl CREATININE 2.0 mg/dl URIC ACID 6.9 mmol/L CALCIUM 10.0 mg/dl PHOSPHOROUS 6.2 mg/dl SODIUM 132 mmol/L POTASSIUM 4.7 mmol/L. .CHLORIDE 101 mmol/L

RFT 20-05-2024 10:01:PMUREA 69 mg/dl CREATININE 1.6 mg/dl URIC ACID 6.8 mmol/L

CALCIUM 9.5 mg/dl PHOSPHOROUS 4.5 mg/dl SODIUM 132 mmol/L POTASSIUM 4.9 mmol/L. CHLORIDE 98 mmol/LSTOOL FOR OCCULT BLOOD 21-05-2024 09:31:AM Negative (-ve)

LIVER FUNCTION TEST (LFT) 22-05-2024 12:12:PMTotal Bilurubin 0.75 mg/dLDirect Bilurubin 0.19 mg/dl SGOT(AST) 20 IU/L SGPT(ALT) 18 IU/LALKALINE PHOSPHATASE 135 IU/L TOTAL PROTEINS 7.5 gm/dlALBUMIN 2.5 gm/dl A/G RATIO 0.50RFT 24-05-2024 11:13:PMUREA 53 mg/dl CREATININE 1.7 mg/dl URIC ACID 4.3 mmol/L CALCIUM 10.2 mg/dl lPHOSPHOROUS 6.4 mg/dl SODIUM 131 mmol/L POTASSIUM 5.7 mmol/L.CHLORIDE 104 mmol/L

USG CHEST - E/O RT MILD PLEURAL EFFUSION,LT MINIMAL PLEURAL EFFUSION

USG ABDOMEN : LEFT GRADE I RPD CHANGES, RIGHT KIDNEY - 10.5X4.6 CM, LEFT KIDNEY- 10.4X4.4CMS

2 D ECHO DONE ON 14/5/24:

IMPRESSION: TACHYCARDIA DURING STUDY, VPC+, MILD GLOBAL HYPOKINESIA,MILD LVH+

MODERATE MR+,MILD AR+,MODERATE TR+, MILD PAH+


EF-54%,FAIR LV FUNCTION
GRADE I DIASTOLIC DYSFUNCTION,NO PE/LV CLOT
IVC-1.83 CMS,DILATED NON COLLAPSING
DILATED LA/RA/RV/IVC/MPA SIZE(2.83 CMS)
MAC+,CALCIFIED AV, NO AS/MS
IAS-INTACT,NO ANEURYSM
REVIEW 2D ECHO DONE ON 22/5/24:
IMPRESSION: VPC DURING STUDY
GLOBAL HYPOKINESIA,PARADOXICAL IVS
MODERATE MR+,MILD AR+,MODERATE TR WITH MILD PAH
EF-54%, FAIR LV SYSTOLIC FUNCTION
GRADE I DIASTOLIC DYSFUNCTION
IVC-1.18 CMS, COLLAPSING
MAC+,SCLEROTIC AV , NO AS/MS
DILATED RA/RV/LA/MPA
COURSE IN THE HOSPITAL : PATIENT WAS ADMITTED I/V/O FEVER SINCE 10 DAYS,SHORTNESS OF BREATH SINCE 5 DAYS AND WAS INVESTIGATED FURTHER AND ON EVALUATION WAS DIAGNOSED WITH ATRIAL FIBRILLATION WITH MODERATE MR,HEART FAILURE WITH PRESERVED EJECTION FRACTION(EF-54 %),? CLINCAL MALARIA,? MESENTERIC ISCHEMIA,K/C/O HTN SINCE 2 YEARS
SURGERY REFERRAL WAS DONE ON 15/5/24 I/V/O OBSTIPATION AND DIFFUSE ABDOMINAL TENDERNESS
ADVISE : HIGH FIBRE DIET , PLENTY OF ORAL FLUIDS, DULCOLEX SUPPOSITORIES
CARDIOLOGY REFERRAL DONE ON 23/5/24 I/V/O SHORTNESS OF BREATH
ADVISED: INJ.LASIX, HEPARIN BRIDGING,TAB.ECOSPIRIN 75 MG,TAB.DILTIAZEM
PATIENT WAS MANAGED CONSERVATIVELY WITH IV ANTIBIOTICS,ANTI PYRETICS,ANTACID,ANTI MALARIAL,ANTI HYPERTENSIVE,STATINS,ANTI PLATELETS,ANALGESIC,DIURETICS,ANTICOAGULANT,ANTI ARRHYTHMICS
PATIENT IS HEMODYNAMICALLY STABLE AT THE TIME OF DISCHARGE
Treatment Given(Enter only Generic Name)
IVF NS ---> URINE OUTPUT + 30ML /HR
INJ. LASIX 40 MG IV /BD
INJ. BUSCOPAN IM/BD

INJ. NEOMOL IF TEMP >101F
INJ.HEPARIN 5000 IU IV/QID 1-1-1-1
TAB.DILITIAZEM 60 MG PO/BD 1-0-1
TAB.LARINATE 200 KIT PO/OD
TAB.ACITROM 2 MG PO/BD 1-0-0
T. TELMA 40 MG PO/OD
T.ATORVAS 20 MG PO/HS
T.ECOSPIRIN 75 MG PO/OD
T.PCM 650 MG PO/SOS
TAB.ULTRACET 1/2 TAB QID /PO
SYP . CREMAFFIN PLUS 75ML PO/TID
OINT THROMBOPHOBE L/A
Advice at Discharge
TAB.LASIX 20 MG PO BD 1-0-1 X 10DAYS
TAB.DILITIAZEM 60 MG PO/BD 1-0-1
T. TELMA 40 MG PO/OD TO CONTINUE
T.ECOSPIRIN-AV 75/20 MG PO/HS
T.PCM 650 MG PO/SOS
TAB.ULTRACET 1/2 TAB PO/QID X 10 DAYS
SYP . CREMAFFIN PLUS 30ML PO/HS X 10 DAYS
TAB.BUSCOPAN PO/BD X 10 DAYS
TAB.PAN 40 MG PO OD X 10 DAYS





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