55/M Pyrexia with ?Septic shock
NAME: Meghana.M
Roll no: 95
Batch: 2017
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55 year old MALE daily wage laborer by occupation, resident of Mandapuram came with chief complaints of
Fever since 10days,
Abdominal pain Since 10 days,
Patient was apparently asymptomatic 15 days back then he developed FEVER high-grade Intermittent, Insidious in onset, gradually progressive, decreased on using medications.
Since day 3 fever was associated With headache, chills and Rigors decreased sleep; decreased intake of food, no nausea. No vomiting, no loose stools. Associated with myalgias and arthralgias, Aggravated at Night, relieved on taking medications
55 YR OLDMALE CAME TO OPD WITH ABOVE MENTIONED COMPLAINTS PATIENT HAD FEVER SPIKES AND HYPOTENSION WITH TACHYCARDIA
ABG 4/3/23
PH; 7.45
PCO2; 26.7 MMHG
P02; 80.1 MM HG
HCO3: 18.0 MMOL/L
TREATED WITH
1. INJECTION CEFTRIAXONE 1000MG (DAY 3)
2. CAP DOXYCYCLINE 100MG
3. INJ FALCIGO 3 DOSES GIVEN
ON 5/3/23
BP. 80.50 MM HG, INJ.NORAD 5ML/HR STARTED
INJ MEROPENEM GIVEN ;
ABG ON 5/3/23
PH: 7.126
PCO2: 19.7 MM HG
P02: 51.3MM HG
S02: 92.7
HCO3: 6.2 mmol/L
INJ. 50mEq H2CO3 given
INJ 100mEQ H2CO3 given IN 100ML NS OVER 1 HR
ON 6/3/23
BP 90/60 MM HG ON INJ. NORAD 14ML/Hr
STARTED ON INJ.VASO 1.6ML/hr
ABG ON 6/3/23
PH: 7.13
PCO2; 22.1 MM HG
P02; 51.6 mm HG
HC03: 7.1 mmol/L
S02: 89.3
CHEST RAY;
NO ABNORMALITY
CULTURES;
BLOOD C/S; NO GROWTH
URINE C/S; NO GROWTH
STOOL C/S: NORMAL INTESTINAL FLORA
EF;64 NO MR/AR/TR
NO RWMA NO AS/MS
GOOD LV SYSTOLIC FUNCTION
DIASTOLIC DYSFUNCTION PRESENT. NO PAH/PE
USG ABDOMEN;
HEMANGIOMA IN SEGMENT 6 OF LIVER
RIGHT RENAL CALCULI 4MM IN LOWER POLE OF RIGHT KIDNEY
MILD SPLENOMEGALY
Inj CEFTRIAXONE 1Gm/Iv/Bd
Inj. FALCIGO 120mg IV @ 0 , 12, 24, 48
Inj. PAN 40mg iv od
Inj Neomol 1gm, iv/sos if temp>101F
Inj. Norad iv/ 14ml/hr
Inj zofer 4mg iv bd
Tab. Doxy 100mg po bd
Tab dolo 650 mg po qid
Tepid sponging + ice packs
LAMANOTES;
THIS IS A CASE OF 55 YR OLD MALE WITH PYREXIA UNDER EVALUATION ?SEPTIC SHOCK SECONDARY TO
?ENTERIC FEVER
?TOXIN MEDIATED ALI
? CLINICAL MALARIA
PATIENT ATTENDERS WERE EXPLAINED ABOUT PATIENT’S CONDITION, NEED FOR FURTHER EVALUATION AND TREATMENT AND COMPLICATIONS, RISK AND POOR PROGNOSIS EXPLAINED IN THEIR OWN LANGUAGE
PATIENT ATTENDER UNDERSTOOD THE ABOVE AND DESPITE
THAT PATIENT ATTENDERS LEFT AGAINST MEDICAL ADVICE
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