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65 year old male ,farmer hailing from nagarjun sagar came to casualty with chief complaints of
● fever since 5 days
● backache since 5 days
History of present illness:
>Patient was apparently asymptomatic 5 days back , then developed high grade continous fever with chills, rigors subsiding on medication(injections taken)
>There was 1 episode of vomiting - non projectile , food particles as contents , no blood
>he had sharp pain in the back radiating to his legs , not relieved on medication ,associated with myalgia
> patient initially had difficulty to pass stools , but gradually was relieved of the problem
>No complaints SOB,cough,burning micturition
Past history :
>5 years back patient had complaints of increased micturition (polyuria)
and was diagnosed as diabetic for which he was on insulin .Inj.MIXTARD 10U(morning) and 8U(night).
>4 years ago patient came to our hospital with c/o SOB and was told to have lung infection ,?mass . He was admitted for 5 days,was advised to stop smoking and drinking
>Since 4 years patient had skin lesions with scaling over legs and hands which progressed gradually, for which he used steroids and tapered.As the lesions kept progressing patient underwent skin biopsy 1month ago at another hospital which showed munromicroabscess suggestive of psoriasis. He has been using medication for psoriasis since 1 month.
>H/O unstable angina 1 and half year back-PCA was done.
>Not a K/C/O HTN,TB,asthma,epilepsy, thyroid disorders.
Personal history:
▪︎Diet-mixed
▪︎Appetite-normal
▪︎sleep-adequate
▪︎Bowel and bladder movements-regular
▪︎Smoker and alcoholic since 25 years but its been over 4 years he stopped both smoking and drinking
Family history:
Not significant,
General examination:
Patient is conscious, coherent, cooperative and is moderately built
No pallor,icterus,cyanosis,clubbing,lymphadenopathy,edema.
Vitals on admission: day 1
Temperature-99 F
PR-64 bpm
RR-18 cpm
BP-80/60 mmHg
Temperature-99 F
PR-64 bpm
RR-18 cpm
BP-80/60 mmHg
Systemic examination:
CVS-S1,S2 heard,No murmurs
RS-BAE present
CNS-No FND
P/A-soft,non tender
Clinical images:
Psoriatic plaques on B/L upper and lower limbs:
Provisional dignosis:
Left lower lobe pneumonia ( bacterial > viral)
With H/O PCA 1 and half year back
With K/C/O DM-type 2
Psoriasis vulgaris
Treatment:
IVF NS @150 ml/hr-bolus given
@75 ml/hr- maintenance
TAB.DOLO 650MG TID
INJ.NEOMOL 1G IV SOS
Temperature charting 4th hrly
INJ.AVIL 2CC SOS(IF CHILLS +)
GRBS monitoring 6th hrly
INJ.HUMAN ACTRAPID ACCORDING TO GRBS
TAB.ECOSPIRIN 75/20 MG PO OD
INJ.PIPTAZ 4G IV QID
Updates-
Day 2:
S- c/o headache and backache
No fever spikes
O-
Pt isC/C/C
Temp- 97.7 F
BP- 120/80 mmHg
PR- 100 bpm
CVS- S1S2 +
RS- BAE+, crepts + in Lt. IAA
P/A- soft, non tender
DM-II +
P-
IVF NS,RL,DNS @75ml/hr
INJ. PIPTAZ 3.375 IV QID
TAB. DOLO 650 mg PO TID
INJ. NEOMOL 1 gm IV SOS
INJ. AVIL 2 cc IV SOS
Inj.PAN 40mg IV OD
INJ. HUMAN ACTRAPID S.C. According to GRBS
TAB. ECOSPIRIN-AV (75/20) mg PO OD
Temp charting 4th hourly
Grbs 6th hrly
Day 3:
S-
One episode of vomiting today morning
Low backache +, Headache+
No fever spikes
O-
Pt isC/C/C
Temp- 97.7 F
BP- 120/80 mmHg
PR- 100 bpm
CVS- S1S2 +
RS- BAE+, crepts + in Lt. IAA
P/A- soft, non tender
Low back pain (2° to ? Radiculopathy)
Leg raising test + at 45° in Left Leg, 60° in Right Leg
P-
IVF NS,RL @100ml/hr
INJ. PIPTAZ 3.375 IV QID
TAB. DOLO 650 mg PO TID
INJ. NEOMOL 1 gm IV SOS
INJ. AVIL 2 cc IV SOS
Inj.PAN 40mg IV OD
Inj.ZOFER 4mg IV BD
INJ. HUMAN ACTRAPID S.C. According to GRBS
TAB. ECOSPIRIN-AV (75/20) mg PO OD
TAB. VITRACET 1/2 PO QID
Temp charting 4th hourly
Grbs 6th hrly
Day 4 :
S-
One episode of vomiting today morning
Low backache +, Headache+
No fever spikes
O-
Pt isC/C/C
Temp- 97.7 F
BP- 120/80 mmHg
PR- 100 bpm
CVS- S1S2 +
RS- BAE+, crepts + in Lt. IAA
P/A- soft, non tender
Low back pain (2° to ? Radiculopathy)
Leg raising test + at 45° in Left Leg, 60° in Right Leg
P-
IVF NS,RL @100ml/hr
INJ. PIPTAZ 3.375 IV QID
TAB. DOLO 650 mg PO TID
INJ. NEOMOL 1 gm IV SOS
INJ. AVIL 2 cc IV SOS
Inj.PAN 40mg IV OD
Inj.ZOFER 4mg IV BD
INJ. HUMAN ACTRAPID S.C. According to GRBS
TAB. ECOSPIRIN-AV (75/20) mg PO OD
TAB. VITRACET 1/2 PO QID
Temp charting 4th hourly
Grbs 6th hrly
Day 5:
S- c/o low backache +
Nausea +, pain abdomen on and off
Chills+ on and off every 4-6hrs
No fever spikes
O-
Pt isC/C/C
Temp- 97.7 F
BP- 120/80 mmHg
PR- 88 bpm
Grbs-130 mg/dl
CVS- S1S2 +
RS- BAE+
P/A- soft, non tender
P-
IVF NS,RL,DNS @75ml/hr
INJ. PIPTAZ 3.375 IV QID
TAB. DOLO 650 mg PO TID
INJ. NEOMOL 1 gm IV SOS if temp >101°F
INJ. AVIL 2 cc IV SOS
Inj.PAN 40mg IV BD
Inj.ZOFER 4mg IV TID
Tab.METFORMIN 250mg PO OD
TAB. ECOSPIRIN-AV (75/20) mg PO OD
Inj.METACHLOPRAMIDE 1amp IV STAT
Temp charting 4th hourly
Grbs 6th hrly
Day 6:
S- c/o low backache (reduced)
Nausea +
Chills+(reduced)
No fever spikes
O-
Pt isC/C/C
Temp- 98.7 F
BP- 150/90 mmHg
PR- 96 bpm
Grbs-115 mg/dl
CVS- S1S2 +
RS- BAE+
P/A- soft, non tender
P-
IVF NS,RL,DNS @100ml/hr
TAB. DOLO 650 mg PO TID
INJ. NEOMOL 1 gm IV SOS if temp >101°F
INJ. AVIL 2 cc IV SOS
Inj.PAN 40mg IV BD
Inj.ZOFER 4mg IV TID
Tab.METFORMIN 250mg PO OD
TAB. ECOSPIRIN-AV (75/20) mg PO OD
Inj.METACHLOPRAMIDE 1amp IV STAT
Temp charting 4th hourly
Grbs 6th hrly
Patient discharged was discharged after 1 week
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