Feverprojr ENTERIC FEVER 32/M

 enteric fever - 

date of admission : 27/03/2024 

date of discharge : 5/4/2024

discharge type : relieved 

ENTERIC FEVER

TYPE I RESPIRATORY FAILURE SECONDARY TO ASPIRATION PNEUMONIA

ALCOHOL WITHDRAWAL SEIZURES WITH DELIRIUM TREMENS

ALCOHOL AND TOBACCO DEPENDANCE SYNDROME

ALCOHOLIC LIVER DISEASE

HYPOKALEMIA SECONDARY TO ACUTE GE [RESOLVED]

Case History and Clinical Findings

PATIENT WAS BROUGHT WITH COMPLAINS OF INVOLUNTARY MOVEMENTS OF UPPERLIMBS AND LOWERLIMBS SINCE 3DAYS

C/O LOOSE STOOLS SINCE YESTERDAY (10EPISODES)

PATIENT APPARENTLY ASYMPTOMATIC 3DAYS AGO THEN DEVELOPED GENERALISED TONIC CLONIC MOVEMENTS OF UL,LL,ASSOCIATED WITH TONGUE BITE AND UPROLLING OF EYEBALLS AND BLEEDING FROM THE BITE SITE AND LSTING FOR 2-3MINS TAKEN TO LOCAL HOSPITAL AND GOT TREATED WITH IV ANTIBIOTICS AND BENZODIAZEPINES

C/O LOOSE STOOLS,NON BLOOD STAINED,WATERY STOOLS FOR EVERY 30MINUTES (APPROX 30 EPISODES/3DAYS)

SOB AT REST SINCE 2DAYS

[2:15 pm, 29/5/2024] Dr.Anahita Behara: NO H/O CHEST PAIN,VOMITINGS,PAIN ABDOMEN

NOT A KNOWN CASE OF HTN,TB,THYROID,ASTHMA,CAD,CVA

PERSONAL HISTORY

APPETITE NORMAL

DIET-NON VEGETERIAN

BOWEL-INCREASED

MICTURITION- NORMAL

NO KNOWN ALLERGIES

CHRONIC ALCOHOLIC 250ML/DAY ,LAST BINGE SATURDAY -90ML

CHRONIC SMOKER

FAMILY HISTORY

NO SIGNIFICANT FAMILY HISTORY

GENERAL EXAMINATION

ICTERUS +

NO PALLOR CYANOSIS CLUBBING AND LYMPHAEDENOPATHY

VITALS AT TIME OF ADMISSION

TEMP-104F

PR: 148BPM

BP:130/80MMHG

RR: 42CPM

SPO2- 86% AT RA

GRBS-128MG/DL

R/S: BILATERAL AIR ENTRY PRESENT

CVS: S1S2 HEARD NO MURMURS

P/A: SOFT, NON TENDER

CNS: DROWSY

E4V4M5

 COURSE IN HOSPITAL : PATIENT WAS BROUGHT TO THE HOSPITAL WITH THE ABOVE SAID COMPALINTS FOR WHICH PATIENT WAS EVALUATED AND TREATED. PSYCHIARTY REFERAL WAS TAKEN I/V/O WITHDRAWL SEIZURES AND WAS DIAGNOSED AS DELIRIRUM TREMORS , ALCHOL WITHDRAWL SYNDROME AND TOBACCO DEPENDANCE SYNDROME AND WAS ADVISED INJ LORAZEPAM 2MG/1/2 AMP IM /SOS , TAB OLANZAPINE 2.5MG PO/HS, THIAMINE SUPLLEMENTATION. PATIENT HAD CONTINUOS FEVER SPIKES AND 4 EPISODES OF LOOSE STOOLS AND PAIN ABDOMEN WAS PRESENT ON FURTHER EVALUATION ENTERIC FEVER WAS DETECTED AND ANTIBIOTICS WERE STARTED. ON FURHTER EVALUATION DECRESED POTASSIUM VALUES WERE PRESENT FOR WHICH ORAL AND IV POTASSIUM CORRECTION WAS DONE. THE PATIENT IS HEMODYNAMICALLY STABLE AND IMPROVED HENCE BEING DISCHARGED WITH FOLLOWING ADVICE

Investigation

HEMOGRAM

HB:11.0(29/03/24)

TLC:11,100

N/L/M/E:50/44/3/3

PCV:35.1

RBC:4.8

PLT:2.7

HB:11.9(29/03/24)

TLC:6700

N/L/M/E:77/12/10/0

PCV:34.8

RBC:3.32

PLT:2.30

HB:10.6(2/04/24)

TLC:8300

N/L/M/E:77/14/01/08

PCV:30.4

RBC:2.93

PLT:1.40

BLOOD UREA 27-03-2024 49 mg/dl 42-12 mg/dl

SERUM CREATININE 27-03-2024 1.3 mg/dl 1.3-0.9 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 27-03-2024

SODIUM 139 mmol/L

POTASSIUM 3.7 mmol/L

CHLORIDE 103 mmol/L

LIVER FUNCTION TEST (LFT) 27-03-2024

Total Bilurubin 2.16 mg/dl

Direct Bilurubin 0.81 mg/dl

SGOT(AST) 85 IU/L

SGPT(ALT) 34 IU/L

ALKALINE PHOSPHATASE 137 IU/L

TOTAL PROTEINS 4.6 gm/dl

ALBUMIN 2.62 gm/dl

A/G RATIO 1.32

HBsAg-RAPID 27-03-2024 Negative

Anti HCV Antibodies - RAPID 27-03-2024 Non Reactive

ABG 27-03-2024

PH 7.52

PCO2 21.1

PO2 47.3

HCO3 17.3

St.HCO3 21.5

BEB -3.2

BEecf -5.1

TCO2 33.1

O2 Sat 88.0

O2 Count 17.7

BLOOD UREA 28-03-2024 31 mg/dl

SERUM CREATININE 28-03-2024 0.9 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 28-03-2024 09:33:P

SODIUM 139 mmol/L

POTASSIUM 3.2 mmol/L

CHLORIDE 106 mmol/L 98-107 mmol/

LIVER FUNCTION TEST (LFT) 29-03-2024

Total Bilurubin 1.37 mg/dl

Direct Bilurubin 0.65 mg/dl

SGOT(AST) 52 IU/L

SGPT(ALT) 28 IU/L

ALKALINE PHOSPHATASE 253 IU/L

TOTAL PROTEINS 4.8 gm/dl

ALBUMIN 2.57 gm/dl

A/G RATIO 1.15

COMPLETE URINE EXAMINATION (CUE) 28-03-2024

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN Nil

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

RFT 29-03-2024

UREA 31 mg/dl

CREATININE 1.1 mg/dl

URIC ACID 2.0 mmol/L

CALCIUM 8.4 mg/dl

PHOSPHOROUS 2.3 mg/dl

SODIUM 139 mmol/L

POTASSIUM 3.1 mmol/L.

CHLORIDE 104 mmol/L

COMPLETE URINE EXAMINATION (CUE) 30-03-2024

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN +

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 2-4

EPITHELIAL CELLS 2-3

RED BLOOD CELLS Nil

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nil

BLOOD UREA 30-03-2024 10:14:P 14 mg/dl 42-12 mg/dl

SERUM CREATININE 30-03-2024 1.0 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 30-03-2024

SODIUM 137 mmol/L

POTASSIUM 2.9 mmol/L

CHLORIDE 99 mmol/L

SERUM ELECTROLYTES (Na, K, C l) 31-03-2024

SODIUM 137 mmol/L

POTASSIUM 3.8 mmol/L

CHLORIDE 102 mmol/L

SERUM AMYLASE 31-03-2024 44 IU/L

RFT 01-04-2024

UREA 20 mg/dl

CREATININE 0.8 mg/dl

URIC ACID 2.0 mmol/L

CALCIUM 8.6 mg/dl

PHOSPHOROUS 3.0 mg/dl

SODIUM 135 mmol/L

POTASSIUM 3.1 mmol/L.

CHLORIDE 101 mmol/L\

RFT 02-04-2024

UREA 14 mg/dl

CREATININE 0.8 mg/dl

URIC ACID 2.4 mmol/L

CALCIUM 9.2 mg/dl

PHOSPHOROUS 2.5 mg/dl

SODIUM 137 mmol/L

POTASSIUM 3.7 mmol/L.

CHLORIDE 98 mmol/L

04/04/24

SODIUM 141 mmol/L

POTASSIUM 4.0 mmol/L.

CHLORIDE 106 mmol/L

USG ABDOMEN ON 28/3/24

GRADE II FATTY LIVER

MINIMAL INTERBOWEL FLUID IN RIF

RT PLEURAL EFFUSION WITH INTERNAL ECHOES

PERICHOLECYSTIC FLUID

IRREGULAR URINARY BLADDER WALL THICKENING WITH INTERNAL ECHOES ? CYSTITIS

SPUTUM CULTURES ON 02/04/24: ZN STAIN; NO ACID FAST BACILLI SEEN.GRAM STAIN; <5 EPITHELIAL CELLS/HPF, 15-10 PUS CELLS/HPF. GRAM POSITIVE BUDDING YEAST CELLS ALONG WITH GRAM POSITIVE COCCI IN SINGLES SEEN.CANDIDA ALBICANS GROWN.

URINE CULTURES ON 29/03/24 : NO PUS CELLS SEEN , NO GROWTH.

BLOOD CULTURES ON 30/03/24: NO GROWTH AFTER 48 HRS OF AEROBIC INCUBATION

03/04/24:NO GROWTH AFTER 1 WEEK OF AEROBIC INCUBATION

2D ECHO ON 28/3/24

NO RWMA

MILD TRIVIAL TR WITH PAH,TRIVIAL AR,TRIVIAL MR

NO AS/MS, 

EF= 65%,RVSP= 32 + 10 = 42MMHG

GOOD LV SYSTOLIC FUNCTION

NO DIASTOLIC DYSFUNCTION

MINIMAL PE

IVC SIZE (1.40CMS) COLLAPSING

MILD DILATED RA/RV

USG CHEST DONE ON 2/4/24: MILD TO MODERATE RIGHT SIDED PLEURAL EFFUSION WITH UNDERLYING CONSOLIDATORY CHANGES.

Treatment Given(Enter only Generic Name)

1) RT INSERTION = 300ML OF COLD SALINE INFUSION

INJ.NEOMOL 1GM /IV/STAT

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

INJ.PIPTAZ 4.5GM /IV/STAT

INJ.PIPTAZ 4.5GM/IV/TID

INJ MONOCEF 1GM/IV/BD FOR 6 DAYS

TAB AZITHROMYCIN 100MG/PO/OD FOR 4 DAYS

INJ.METROGYL 500MG/IV/TID

T.PCM 650MG /RT/QID

INJ.THIAMINE 400MG IN 500MG/NS/IV/STAT

INJ.THIAMINE 200MG /IV/BD

INJ.LORAZEPAM 2CC/IV/STAT

INJ.LEVIPIL 1GM/IV/STAT

INJ.LEVIPIL 500MG/IV/BD

INJ.OPTINEURON 1AMP IN 100ML NS/IV/OD

INJ.MIDAZOLAM 1AMP IN 20ML NS IV INFUSION AT 2ML/HR

IVF NS,RL AT 75ML/HR

ORAL AND IV POTASSIUM CORRECTION GIVEN

TEPID SPONGING

Advice at Discharge

TAB PAN 40MG PO/OD X 7DAYS

TAB TAXIM 20MG PO/BD X 1 DAY

TAB AZITHROMYCIN 1G PO/OD X 3 DAY

TAB LEVIPIL 500MG/PO/BD TO CONTINUE

TAB COMBIFLAM PO/TID X 2 DAYS FB SOS

TAB LORAZEPAM 2MG PO/OD 0-0-1TAB X 1WEEK

TAB LORAZEPAM 2MG PO/OD 0-0-1/2 TAB X 1WEEK

TAB OLANZEPINE 2.5MG PO/BD 1-0-2 X 15 DAYS

TAB BACLOFEN XL 20MG PO/BD 1-0-1

COFSILS LOZENGES PO/SOS

SYP GRILLINCTUS DX 10ML PO/TID X 3DAYS

TAB MONTEK-LC PO/OD 0-0-1 X 3DAYS

ORS SACHETS IN 200ML WATER PO

NICOTINE GUMS BD 1-0-1 &SOS

HEAD END ELEVATION

PRECAUTIONS DURING ORAL FEEDS EXPLAINED TO PT ATTENDERS

STRICT ABSTINENCE FROM ALCOHOL AND TOBACCO.