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CASE PRESENTATION:
A 50 year old female came to casualty with c/o
Fever since 7 days
HOPI:
Patient was apparently asymptomatic 7 days back then she developed fever which is of high grade,intermittent, not associated with chills and increased during night.2 days later She went to a local hospital where she was diagnosed with typhoid.she was on medication. Her platelets count reduced and fever is not subsided.
She also complained of mild head ache since 4 days ,relieved on medication
No h/o nausea, vomiting
No h/o loose stools/constipation
No h/o pain abdomen
No h/o Burning micturition
PAST HISTORY:
Not a K/C/O DM/HTN/ASTHMA/EPILEPSY/CAD/CVA
Personal History :
Diet : mixed
Appetite : Normal
Sleep : Adequate
Bowel movements : Regular
Bladder movements : Regular
On Examination :
Patient is conscious, coherent and cooperative.
Pallor -Absent
Icterus -Absent
Cyanosis -Absent
Clubbing -Absent
Lymphadenopathy -Absent
Edema -Absent
VITALS :
AT THE TIME OF ADMISSION :
TEMP. : 98.6
PR : 88 BPM
RR : 16 CPM
BP : 100/60 MM HG
SpO2 (on Room air) : 98%
GRBS:108 GM/DL
On Systemic Examination:
CVS : S1, S2 heard
RS : BAE present
P/A : soft, Non tender
CNS : HMF Intact
INVESTIGATIONS
On 24/10/22
On 25/10/22
Hb- 11.2 gm/dl
TLC-5,200
Pt count-1.5
RBC-3.86
On 26/10/22
Hb- 11.2 gm/dl
TLC-5,200
Pt count-1.5
RBC-3.86
PROVISIONAL DIAGNOSIS:VIRAL PYREXIA WITH THROMBOCYTOPENIA
TREATMENT:
1.IV FLUIDS NS@70 ML /HR
2.TAB.PCM 650 MG/PO/TID
3.INJ.PAN 40 MG/IVBD
4.INJ.ZOFER 4MG/IV/SOS
5.INJ.NEOMOL 1GM/IV/SOS
6.VITALS MONITORING
MEDICAL WARD
Day 1(24/10/22)
S:
No fever spikes
O:
Patient is conscious, coherent and co-operative
Temp : 98 F
BP : 100/60 mmHg
PR : 72 BPM
RR : 24 CPM
GRBS:108 GM/DL
A:
VIRAL PYREXIA WITH THROMBOCYTOPENIA
P:
1.IV FLUIDS NS@70 ML /HR
2.TAB.PCM 650 MG/PO/TID
3.INJ.PAN 40 MG/IVBD
4.INJ.ZOFER 4MG/IV/SOS
5.INJ.NEOMOL 1GM/IV/SOS
6.INJ.CEFTRIAXONE 1 GM/IV/BD
7.MONITOR VITALS
MEDICAL WARD
Day 2(25/10/22)
S:
Fever spikes(2 episodes)
Dry cough +
O:
Patient is conscious, coherent and co-operative
Temp : 99 F
BP : 120/70 mmHg
PR : 84 BPM
RR : 22 CPM
GRBS:124 GM/DL
A:
VIRAL PYREXIA WITH THROMBOCYTOPENIA
P:
1.IV FLUIDS NS@70 ML /HR
2.TAB.PCM 650 MG/PO/TID
3.INJ.PAN 40 MG/IVBD
4.INJ.ZOFER 4MG/IV/SOS
5.INJ.NEOMOL 1GM/IV/SOS
6.INJ.CEFTRIAXONE 1 GM/IV/BD
7.SYP.BENADRYL 10 ML/PO/TID
8.TAB.DOXY 100 MG PO/BD
9.INJ.FALCIGO 120 MG AT 11 AM, 11 PM AND 11 AM
10. MONITOR VITALS
AMC CUBICLE 2
Day 3(26/10/22)
S:
Fever spikes
O:
Patient is conscious, coherent and co-operative
Temp : 102 F
BP : 110/70 mmHg
PR : 98 BPM
RR : 18 CPM
GRBS:124 GM/DL
A:
VIRAL PYREXIA WITH THROMBOCYTOPENIA (resolved)
P:
1.IV FLUIDS NS@100 ML /HR
2.TAB.PCM 650 MG/PO/QID
4.INJ.PAN 40 MG/IV/OD
5.INJ.NEOMOL 1GM/IV/SOS(if temp>101F)
6.SYP.BENADRYL 10 ML/PO/TID
7.TAB.DOXY 100 MG PO/BD
8.INJ.FALCIGO 120 MG AT 11 AM
9. MONITOR VITALS
AMC CUBICLE 2
Day 4(27/10/22)
S:
Fever spike@ 4 am
Cough @night
O:
Patient is conscious, coherent and co-operative
Temp : 102 F
BP : 120/70 mmHg
PR : 69 BPM
RR : 18 CPM
RS-BAE+
CVS -S1S2+
CNS-NO FND
A:
VIRAL PYREXIA WITH THROMBOCYTOPENIA (resolved)
P:
1.IV FLUIDS NS@100 ML /HR
2.TAB.PCM 650 MG/PO/QID
4.INJ.PAN 40 MG/IV/OD
5.INJ.NEOMOL 1GM/IV/SOS(if temp>101F)
6.SYP.BENADRYL 10 ML/PO/TID
7. MONITOR VITALS
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