45 year old male patient,working as security came to the casuality with the chief complaints of fever and yellowish discolouration of eyes and urine since 10 days . 

In 2008 , Patient got admitted in hospital for fever ,he was diagnosed of having jaundice and on medications for 3 months regularly. 

Patient was apparently asymptomatic 10 days back then he developed fever after doing continuous night duties for a week .

Fever ,is continuous ,associated with chills and rigors, relieved on medication( paracetamol,relieves for 1 hour and fever again progresses).

No H/O headache , pedal edema , cough , cold , SOB,burning micturition , chest pain ,melena , night sweats .

H/O mouth ulcers (lower lip) , since 5 days 

had past h/o mouth ulcers , which got relieved by themselves without using any medications .

Not a k/c/o DM,HTN,thyroid ,epilepsy. 

K/c/o alcoholic and tobacco chew since 20yrs.

Patient used to drink alcohol since 20yrs occasionally,but started drinking regularly since 9 yrs ( Drinks whisky 90ml daily ) ,last drink taken 1 week back. 

He used to chew tobacco since 20 yrs daily( 2 packs/day )

He got referred to psychiatry,in view of alcohol dependence.






GENERAL EXAMINATION - 

Patient is c/c/c ,moderately build and nourished .



Pallor : absent



Icterus : present 


No Clubbing , edema , lymphadenopathy.


Due to trauma 

Gait

VITALS 

Temp: 102 

BP: 80/60mmhg

PR: 82bpm 

RR:20cpm 

SPO2: 98% 

GRBS: 136mg/dl 

CVS : s1s2 heard no murmurs 

RESP: Bilateral breath sounds equal .

P/A: soft , non tender 

mild spleenomegaly.

CNS : patient is hypoactive ,

CNS EXAMINATION


youtu.be

youtu.be

https://youtu.be/An52WSt7pqk

https://youtu.be/G7LHAUX5jQ0

https://youtu.be/td0lKFDP9_Y
youtu.be

https://youtu.be/xWlsUfK3Y90
https://youtu.be/VgQhePag6ig

https://youtu.be/3haZPjc0c_Q

https://youtu.be/F1t3uBSbrRQ


















27/12/20- 










DIAGNOSIS- Fever with anemia secondary to B12 deficiency,with alcohol liver disease with grade 1 hepatic encephalopathy (acc to west haven criteria ) with AKI resolved .


TREATMENT- 
Day 1 
Tab lasix 40mg IV BD 
Tab Rifaximine 150mg POBD 
syrup lactulose 15ml po H/S
temp monitoring and tepid sponging 
salt and fluid restriction 
maintain 2,3 stools / day 
Inj thiamine 1amp in 100 ml NS OD 
tab pcm 500mg PO 

Day 2 
inj pantop IV /SOS
Inj Zofer IV /SOS 
syrup lactulose 15ml po H/S
temp monitoring and tepid sponging 
salt and fluid restriction 
maintain 2,3 stools / day 
Inj thiamine 1amp in 100 ml NS OD 
tab pcm 500mg PO 

Day 3 
Inj lasix 40 mg IV/Bd 
inj monecef 1gm IV/TID 
inj thiamine 1amp in 100ml NS 
Inj Optinueron 1 amp 100ml NS OD 
Inj vit B12 1000mg IM /OD 
syrup lactulose 15ml po H/S
maintain 2,3 stools / day 
Syrup Aristozyme Po/TID 
Salt restriction <2gm/day , fluid restriction <1lt/day 
temp monitoring and tepid sponging 

Day 4 

Inj lasix 40 mg IV/Bd 
inj monecef 1gm IV/TID 
inj thiamine 1amp in 100ml NS 
Inj Optinueron 1 amp 100ml NS OD 
Inj vit B12 1000mg IM /OD 
syrup lactulose 15ml po H/S
maintain 2,3 stools / day 
Syrup Aristozyme Po/TID 
Salt restriction <2gm/day , fluid restriction <1lt/day 
temp monitoring and tepid sponging 
tab .Folvite 5mg PO/OD

Comments

Post a Comment

Popular posts from this blog

36 yr old male with facial puffiness after exposure of unknown smoke ....

36 yr old male patient came with the c/o facial puffiness since yesterday. Patient was apparently a symptomatic till yesterday evening,then developed facial puffiness and lips  (gradual in onset ,progressive in nature ) after exposure to an unknown smoke .c/o change of voice since yesterday. C/o difficulty in swallowing both liquid and solid since yesterday not associated with SOB ,pain abdomen .H/o angioedema since 15 yrs .H/o intermittent urticaria on thigh on contact with allergens like smoke ,agarbathi , spirit , plastic waste burns , hand wash , soaps (other than Santoor),ice (other cold substance) Contact food (brinjal ,wheat,fish, mutton ,gongura,ice cream )  H/O tracheostomy done twice (2006 and 2017) Not k/c/o HTN,DM  Not on any known medications  No c/o pedal edema ,burining micturition ,fever , cold , palpitations and giddiness . GENERAL EXAMINATION- Pt is c/c/c , moderately build and nourished . Vitals-  Temp:afebrile BP: 130/80mmhg PR : 118bpm  RR: 21cpm GRBS: 155mg/dl
Read more

Bimonthly assessement

Image
1) A 55 year old man with Recurrent Focal Seizures Detailed patient case report here:  http://ushaindurthi. blogspot.com/2020/11/55-year- old-male-with-complaints-of. html 1. What is the problem representation of this patient and what could be the anatomical site of lesion ? Ans-Pt (55 year old male )presented with the complaints of unable to move his right upper limb, since yesterday and recurrent episodes of seizures since one day . Antomical site of lesion is RT temporal lobe ,epileptogenic focus. 2. Why are subcortical internal capsular infarcts more common that cortical infarcts? subcortical infarcts are caused by occlusion of a penetrating arteries These arteries arise at sharp angles from major vessels so subcortical infarcts are more common that cortical . 3. What is the pathogenesis involved in cerebral infarct related seizures? 4. What is your take on the ecg? And do you agree with the treating team on starting the patient on Enoxaparin? ST depressions noted in  leads V1 to V
Read more