feverprojr - ENTERIC FEVER - 81/F 202300561

 enteric fever -

date of admission : 4/1/2023 

date of discharge : 17/1/2023

discharge type : relieved

DISTRIBUTIVE SHOCK ( RESOLVED ) SECONDARY TO SEPSIS -ENTERIC FEVER( CEFTRIAXONE RESISTANT ) ( RESOLVED )WITH BICYTOPENIA ( RESOLVED ) TYPE:1 RESPIRATORY FAILURE SECONDARY TO B/L PLEURAL EFFUSION (TRANSUDATIVE WITH BASAL ATELECTASIS) ( RESOLVED )

Case History and Clinical Findings

A 80 YEAR OLD FEMALE PRESENTED WITH CHIEF COMPLAINTS OF FEVER SINCE 1 WEEK

PATIENT WAS APPARENTLY ASYMPTOMATIC 1 WEEK BACK THEN SHE COMPLAINED OF FEVER OF HIGH GRADE(104F), INTERMITTENT, NOT ASSOCIATED WITH CHILLS AND RIGORS.FEVER GET RELIEVED ON MEDICATION.ASSOCIATED WITH HEAD ACHE. THERE IS NO HISTORY OF VOMITINGS,LOOSE STOOLS, PAIN ABDOMEN, COLD, COUGH, BURNING MICTURITION.

COURSE IN HOSPITAL :

PATIENT WAS ADMITTED WITH CHEIF COMPLAINTS OF FEVER SINCE 7 DAYS , ASSOCIATED WITH CHILLS , AND HEADACHE SINCE 7 DAYS , GENERALISED WEAKNESS SINCE 2 DAYS

PATIENT WAS ADMITTED WITH CHIEF COMPLAINTS OF FEVER SINCE 7 DAYS , ASSOCIATED WITH CHILLS , AND HEADACHE SINCE 7 DAYS , GENERALISED WEAKNESS SINCE 2 DAYS . ON ADMISSION SHE WAS FOUND TO HAVE HYPOVOLEMIC SHOCK SECONDARY TO SEPSIS WITH THROMBOCYTOPENIA . SHE HAS LOW BLOOD PRSSURE FOR WHICH SHE WAS ADMINISTERED IONOTROPES FOR 1 DAY , IV FLUIDS , ANTIBIOTICS , NEBULIZATIONS AND TREATED ADEQUATEDLY . HER URINE AND BLOOD CULTURE SHOWS NO GROWTH , HER ECG, 2D ECHO AND USG ABDOMEN AND PELVIS SHOW NO ABNORMALITY .

ON DAY 5 OF ADMISSION SHE WAS FOUND TO HAVE TYPE 1 RESPIRATORY FAILURE SECONDARY TO INTERSTITIAL PNEUMONIA . HRCT CHEST SHOWS MODERATE B/L PLEURAL EFFUSION WITH BASAL ATELECTASIS AND MEDIASTINAL LYMPHADENOPATHY FOR WHICH PULMONOLOGY REFERRAL WAS TAKEN ON 11/11/1/23 AND ADVISE FOLLOWED .

DIAGNOSTIC PLEURAL TAP WAS DONE AND CULTURE OF IT SHOWS FEW DISINTEGRATED PUS CELLS , OCCASIONAL GRAM NEGATIVE BACILLI , AFB NEGATIVE . URIN CULTURE SHOWED E COLI >/ 105 CFU / ML . AS THERE AS FEBRILE NEUTROPENIA SHE WAS GIVEN AZITHROMYCIN 1 GM / DAY .

AFTER ADEQUATE TREATENT HER DISTRIBYUTIVE SHOCK WAS RESOLVED , THROMBOCYTOPENIA WAS RESOLVED .

PATIENT WAS DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION .

NOT A KNOWN CASE OF DM, HTN, ASTHMA, EPILEPSY, CAD, CVD.

PERSONAL HISTORY:

APPETITE:NORMAL DIET:MIXED BOWEL AND BLADDER HABITS:REGULAR NO ADDICTIONS

NO SIGNIFICANT FAMILY HISTORY

GENERAL EXAMINATION:

PATIENT WAS CONSCIOUS, COHERENT, CO-OPERATIVE

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

VITALS: 

TEMP- 104.5F 

BP- 80/50MM HG 

PR- 150BPM 

RR-16CPM

 SPO2- 99% ON RA 

GRBS-123 MG/DL

 SYSTEMIC EXAMINATION:

 CARDIOVASCULAR SYSTEM : S1, S2 HEARD, NO MURMURS 

RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT.NORMAL VESICULAR BREATH SOUNDS HEARD.POSITION OF TRACHEA CENTRAL.

RT LL COARSE CREPTS+ 

CENTRAL NERVOUS SYSTEM : PATIENT IS CONSCIOUS, COHERENT AND COOPERATIVE. HIGHER MENTAL FUNCTIONS INTACT

PER ABDOMINAL EXAMINATION : SOFT , NON TENDER , BOWEL SOUNDS HEARD , NO SIGNS OF ORGANOMEGALY

Investigation

2 D ECHO :( 5/1/2023 )NO RWMA , MILD LVH , MODERATE MR + , MODERATE TR PRESENT WITH PAH , MODERATE AR +.- SCLEROTIC THICKENED AV , NO AS/MS.- GOOD LV SYSTOLIC FUNCTION , DIASTOLIC DYSFUNCTION PRESENT . NO PE , IVC SIZE 1.15 CMS , MILD COLLAPSING MILD DILATED LA/RA.NO PE - ON 12/1/23 :NO RWMA , MILD LVH , MODERATE MR + , MODERATE TR PRESENT WITH PAH , MODERATE AR +SCLEROTIC THICKENED AV , NO AS/MSGOOD LV SYSTOLIC FUNCTION , DIASTOLIC SYSFUNCTION PRESENT . NO PE

ECG : NORMAL SINUS RHYTHM

USG ABDOMEN AND PELVIS : NO SONOLOGICAL ABNORMALITY DETECTED

HRCT OF THORAX PLAIN :MODERATE BILATERAL PLEURAL EFFUSION WITH BASAL ATELECTASIS PROMINENT MEDIASTINAL LYMPHADENOPATHY

BACTERIAL CULTURE AND SENSITIVITY REPORT( BLOOD ) : NO GROWTH

BACTERIAL CULTURE AND SENSITIVITY REPORT 

 : E COLI >/ 100000 CFU /ML OF URINE ISOLATED

HEMOGRAM (4/1/23 ) :HB 11.4 GM/DL

TLC 9,200MCV 86.4

RBC. 4.03 millions / cumm

PLT. 100000

HEMOGRAM ON 5/1 :

HB : 11.4 GM / DL ,

 TC : 9200 ,

 MCV : 86.4 ,

 PCV : 34.8 ,

 RBC : 4.03 MILL/CU MM ,

 PLT : 1.0 LACS/CU MM

HEMOGRAM ON 7/1/23 :

 HB : 9.8 GM /DL , 

TC : 7500 , 

PCV : 30.1 , 

MCV : 87.8 ,

 RBC : 3.43 MILL/CU MM , 

PLT :' 1.36 LACS / CU MM

HEMOGRAM ON 9/1/23 :

 HB : 9.7 GM /DL 

, TC : 3300 ,

 PCV : 29.9 ,

 MCV : 87.4 ,

 RBC : 3.42 ,

 PLT : 1.5 LACS /CU MM

HEMOGRAM ON 11/1 :

 HB : 9.7 ,

 TC : 3000,

 PCV : 29.8 ,

 MCV : 87.1 ,

 RBC : 3.4 MILL/CU MM , 

PLT : 1.5 LACS / CU MM

HEMOGRAM ON 13/1 :

 HB : 8.2 GM / DL ,

 TC : 4000 , 

PCV : 26.1 ,

 MCV : 90 ,

 RBC : 2.9 MILL / CU MM , 

PLT : 1.5 LACS / CU MM

ON 15/1 :

 HB : 9.5 GM / DL ,

 TC : 5500 , 

PCV : 29.8 ,

 M,CV : 89.5 ,

 RBC : 3.33 MILL / CU MM ,

 PLT : 1.5 LACS / CU MM

ON 17/1 :

 HB : 9.1 GM / DL ,

 TC : 6000 / CU MM ,

 MCV : 91.5 ,

 PCV : 28. 9 

, RBC : 3.18 MILL/ CU MM 

, PLT : 1.5 LACS / CU MM

Treatment Given(Enter only Generic Name)

IV FLUIDS NS , RL @ 50 ML / HR

INJ . OPTINEURON 1 AMP IN 500 ML NS IV / OD

INJ NEOMOL 1GM IV IF TEMP >: 101 F

TAB DOLO 650 MG PO/SOS

SYP.POTKLOR 15 ML PO/TID

OXYGEN INHALATION WITH NASAL SPONGES 2-4 LIT / MIN TO MAINTAIN SPO2 >99

NEBULISATION WITH IPRAVENT 6 TH HRLY , BUDECORT 4 TH HRLY

INJ LASIX 40 MG IV /OD

INJ MONOCEF 1 GM IV /BD

INJ DOXY 100 MG IV / BD

ORS SACHETS IN I LITRE WATER 200 ML EVERY 2 HRS

TEMP MONITORING DONE 4 TH HRLY

PLENTY OF ORAL FLUIDS

Advice at Discharge

TAB BECOZINC PO/OD X 7 DAYS

TAB NITROFURANTOIN 100 MG PO/BD X 5 DAYS

SYP POTKLOR 15 ML PO/TID X 3 DAYS

ORS SACHETS IN 1 LIT WATER 200 ML FOR EVERY 2 HRS

PLENTY OF ORAL FLUIDS