feverprojr FUNGAL 75/M

 fungal : 75 year old male 

date of admission : 17/2/2024 

date of discharge : 27/2/2024 



ACUTE EXACERBATION OF COPD SECONDARY TO COMMUNITY AQUIRED PNEUMONIA (?FUNGAL)-RESOLVING

CHRONIC KIDNEY DISEASE ON MHD

MULTIPLE ACUTE DUODENAL ULCERS(FORREST TYPE-IIC)

MINERAL BONE DISEASE

HEART FAILURE WITH PRESERVED EJECTION FRACTION.

OLD PULMONARY TB 10 YEARS AGO

Case History and Clinical Findings

C/O SHORTNESS OF BREATH SINCE 3DAYS

C/O DECREASED URINE OUTPUT SINCE 20 DAYS

C/O COUGH SINCE 20 DAYS

HOPI- PT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK THEN HE DVELOPED SOB , SUDDEN ONSET,GRADUALLY PROGRESSIVE FROM GRADE II TO GRADE IV. WITH DIFFUSE WHEEE PRESENT.

H/O COUGH SINCE 20 DAYS WITH SCANTY SPUTUM,NON FOUL SMELLING, NOT BLOOD TINGED.

H/O DECREASED URINE OUTPUT SINCE 20 DAYS WITH DRIBBLING OF URINE.

NO H/O COLD, FEVER, BURNING MICTURITION, PAIN ABDOMEN, LOOSE STOOLS, VOMITING.

PAST H/O-

K/C/O CKD SINCE 4 YRS ON DIALYSIS SINCE 20 DAYS


H/O PULMONARY TB 10 YRS AGO , USED ATT FOR 1 YR

H/O ASTHMA 10 YRS AGO ,USED INHALER IRREGULARLY

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

GENERAL EXAMINATION

PT IS C/C/C

PALLOR+

NO ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA.

PR- 96 BPM

BP- 120/80 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+,

COARSE CREPTS+ IN RIGHT ISA, LEFT IAA, ISA,

DECREASED BREATH SOUNDS IN LEFT IAA, ISA

PA- SOFT, NON TENDER

1 UNIT OFPRBC TRANSFUSION WAS DONE ON 22/2/24, TRANSFUSION UNEVENTFUL

Investigation

SPUTUM FOR C/S :-NON-ALBICANS CANDIDA GROWN.

BLOOD FOR C/S:-NO GROWTH AFTER 1WEEK OF AEROBIC INCUBATION.

SPUTUM FOR GRAM STAIN AND KOH: KLEBSIELLA PNEUMONIA.

BLOOD UREA 18-02-2024 04:11:AM 134 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 18-02-2024 04:12:AM

SODIUM 135 mEq/L

POTASSIUM 3.8 mEq/L

CHLORIDE 104 mEq/L

CALCIUM IONIZED 1.19 mmol/L

SERUM CREATININE 18-02-2024 04:12:AM 6.0 mg/dl


PERIPHERAL SMEAR 18-02-2024 04:12:AM RBC : Normocytic normochromic anemia WBC : With in normal limits PLATELET : Adequate

RFT

UREA133mg/dl

CREATININE 8.4mg/dl

URIC ACID6.9mg/dl

CALCIUM9.9mg/dl

PHOSPHOROUS4.4mg/dl

SODIUM138mEq/L

POTASSIUM3.6mEq/L

CHLORIDE100mEq/L

HEMOGRAM

HAEMOGLOBIN 8.5gm/dl

TOTAL COUNT 12,300cells/cumm

NEUTROPHILS74

LYMPHOCYTES15

EOSINOPHILS 01

MONOCYTES10

BASOPHILS00

RBC COUNT2.78millions/cumm

PLATELET COUNT1.72lakhs/cu.mm

IMPRESSION :Normocytic normochromic Anemia with leukocytosis.

UPPER GI ENDOSCOPY:

MULTIPLE ACUTE DUODENAL ULCERS, ANTRAL GASTRITIS.

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION <1.5 L/DAY

SALT RESTRICTION <2 G/DAY

INJ IRON SUCROSE 200MG IV/OD WEEKLY TWICE

INJ EPO 4000 IU S/C WEEKLY TWICE

INJ.PAN 4O MG IV/BD

TAB. AUGMENTIN 625 MG PO/BD

TAB.AZITHROMYCIN 500MG PO/BD.

TAB.VORICONAZOLE 200MG PO/BD


TAB.NICARDIA 20MG PO/OD

TAB. LASIX 40 MG PO/BD

TAB. OROFER-XT PO/OD

TAB. SHELCAL CT PO/OD

TAB. NODOSIS 1000 MG PO/BD

T.PULMOCLEAR PO/TID

SYRUP CREMAFFIN PLUS 20ML PO/HS

SYRUP ASCORYL LS 15 ML PO/ TID

SYRUP SUCRALFATE 15ML PO/BD

NEB WITH BUDECORT 8TH HRLY ; DOULIN 6TH HRLY

Advice at Discharge

FLUID RESTRICTION <1.5 L/DAY

SALT RESTRICTION <2 G/DAY

INJ IRON SUCROSE 200MG IV/OD WEEKLY TWICE

INJ EPO 4000 IU S/C WEEKLY TWICE

TAB.PAN 4O MG PO/BD X 10 DAYS

TAB.VORICONAZOLE 200MG PO/BD X 7 DAYS

TAB.NICARDIA 20MG PO/BD

TAB. LASIX 40 MG PO/BD

TAB. OROFER-XT PO/OD

TAB. SHELCAL CT PO/OD

TAB. NODOSIS 1000 MG PO/BD

T.PULMOCLEAR PO/TID X 10 DAYS.

SYRUP CREMAFFIN PLUS 20ML PO/HS X 7 DAYS

SYRUP ASCORYL LS 15 ML PO/ TIDX 10 DAYS

SYRUP SUCRALFATE 15ML PO/BD X 14DAYS

NEB WITH BUDECORT 8TH HRLY ; DOULIN 6TH HRLY X 10 DAYS.








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