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26yr old with pyrexia

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 



Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 



This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment


26 YR OLD MALE WITH FEVER SINCE I WEEK, VOMITINGS, LOOSE STOOLS SINCE 3 DAYS

Cheif complaints : 

26 year old male presented with cheif complaints of fever since 1 week

Generalised weakness and headache since 1 week

Vomitings since 3 days

Loose stools since 3 days

History of presenting illness:

Patient was apparently alright 1week ago then he developed fever which is high grade, intermittent, associated with chills and rigor.

He was in Orissa while he developed fever then he returned to his home 2 days later.He could not do his daily usaual work due to high grade fever and headache

He also had headache and generalised weakness since 1 week

Patient has fever with headache which is not associated with altered sensorium (meningitis -), not associated with photophobia, phonophobia(intra cranial injury -), diffuse headache (migrane -). 

He developed vomitings since 3 days, 5 episodes, with food as content, non bilious, non projectile, not blood stained

Loose stools since 3 days, 3 episodes/day, watery, green coloured, not blood stained.

He went to a doctor outside but the symptoms didnot subside, then he came here on 7/6/23

H/o hematuria and green coloured stools since 3 days

There is H/o taking papaya leaf juice for 3days in the morning before food 

Past history 

No H/o similar complaints in the past

Not a k/c/o DM, HTN, Thyroid disorders, epilepsy, asthma.

Personal history 

He has normal appetite, takes mixed diet, increased bowel movements, sleep is adequate.

He takes alcohol 2 quarters from 6 years 

On examination:

Patient is conscious, coherent and cooperative 

No pallor, clubbing, cyanosis, lymphadenopathy, pedal edema 












Vitals

Temp- 99.5F

PR- 86 bpm

RR- 20 cpm

BP- 100/70mmHg

Spo2 - 99% on RA



RS-B/L air entry present 

       NVBS

CVS- S1S2 present, no murmurs heard

PA- Soft,non tender

CNS: NAD



Investigations 

On 7/6/23

Hb: 14.9gm/dl

TLC: 900cells/cumm

RBC: 4.79 millions/cumm

PLATELETS: 50000 /cumm



Blood urea:52 mg/dl

Serum creatinine: 1.4 mg/dl


Serum Na+:139 mEq/L

Serum K+:4.0mEq/L

Serum Chloride:101 mEq/L


Bleeding time: 2min 30sec

Clotting time: 5min 00sec


PT: 20sec

INR: 1.4

APTT:41 sec



Stool for occult blood: Positive 


CUE

Albumin:+

Pus cells: 3-4/HPF

RBC: plenty


On 8/6/23

Hb: 13.3gm/dl

TLC: 900cells/cumm

Platelets: 50000 /cumm

RBC: 4.17million/cumm



Peripheral smear

RBC: Normocytic normochromic

WBC: counts decreased on smear

Platelet: counts decreased on smear




On 9/6/23

Hb: 12 gm/dl

TLC: 1300cells/cumm

RBC:3.78million/cumm

Platelets: 90,000/cumm

PCV: 35.4vol%


Serum creatinine:0.9mg/dl

Serum Na+ :139mEq/L

Serum K+: 4 mEq/L

Serum Chloride: 101mEq/L



APTT:43 Sec

PT: 22Sec

INR:1.62



Total Bilirubin: 4.93 mg/dl

Direct bilirubin: 3.46mg/dl

SGOT: 50 IU/L

SGPT: 18IU/L

Total proteins 5.0gm/dl

Albumin: 2.44gm/dl

A/G ratio: 0.95



On 10/6/23


Total Bilirubin: 2.37 mg/dl

Direct bilirubin: 1.99 mg/dl

SGOT: 79 IU/L

SGPT: 25 IU/L

Total proteins 4.5 gm/dl

Albumin: 1.69 gm/dl

A/G ratio: 0.58


Hb: 11.5 gm/dl

TLC: 1100 cells/cumm

RBC:3.63 million/cumm

Platelets: 62,000/cumm

PCV: 34.2 vol%


On 11/6/23


Total Bilirubin: 1.57 mg/dl

Direct bilirubin: 0.65 mg/dl

SGOT: 64 IU/L

SGPT: 30 IU/L

Total proteins 4.6 gm/dl

Albumin: 2.21 gm/dl

A/G ratio: 0.92


Hb: 11.3 gm/dl

TLC: 2000 cells/cumm

RBC: 3.58 million/cumm

Platelets: 70,000/cumm

PCV: 34 vol%


On 12/6/23


Hb: 11.6 gm/dl

TLC: 2400 cells/cumm

RBC: 3.66 million/cumm

Platelets: 80000/cumm

PCV: 35.2 vol%


Total Bilirubin: 1.17 mg/dl

Direct bilirubin: 0.23 mg/dl

SGOT: 62 IU/L

SGPT: 49 IU/L

Total proteins 6.2 gm/dl

Albumin: 3.3 gm/dl

A/G ratio: 1.74


Serum electrolytes 

Serum Na+ :140mEq/L

Serum K+: 4mEq/L

Serum Chloride: 100mEq/L

Differential diagnosis

Salmonella typhi? , E. Coli?, Entameoba hystalytica?, malaria? 


Diagnosis:

Pyrexia with pancytopenia


Treatment:

1.IV FLUIDS NS, DNS, RL@ 125 ml/hr  

2.Tab.DOLO 650mg PO/TID

3.Inj.NEOMOL 1gm IV/SOS (if temp>102F)

4.Monitor vitals


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R.sriharsha ;reg no:1701006146

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CASE : CHIEF COMPLAINTS : A 64yr old male Patient came to casuality with chief complaints of  - unable to talk since 4 days - hiccups since 7 days - bowel and bladder incontinence, loss of appetite since 3 days  - loose stools 5 days back relieved on medication  - fever 4 days back  HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 7 days back , he then developed hiccups , loss of speech - 5 days back he developed diarrhoea 5 episodes/ day , for one day which was relieved on medication  -loss of appetite since 3 days , since one day he is unable to talk   - No H/O SOB , cough , palpitations - No H/O loss of consciousness , giddiness , involuntary passage of urine and stools . PAST HISTORY : h/o panic attack one month back secondary to family issues  - K/C/O DM2 since 2 yrs , on medication ,  -tab Metformin OD , tab Glimiperide OD - Not a K/C/O HTN, TB, Asthma, epilepsy, CAD, CVD PERSONAL HISTORY: Appetite - lost Diet - Mixed  Sleep - adequate Bowel and bladder movemen
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1701006146 prefinal case

June 12, 2023
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26 YR OLD MALE WITH FEVER SINCE I WEEK, VOMITINGS, LOOSE STOOLS SINCE 3 DAYS Cheif complaints  26 year old male came with c/o Fever since 1 week c/o generalised weakness and headache since 1 week c/o vomitings since 3 days c/o loose stools since 3 days History of presenting illness : Patient was apparently alright 1week ago then he developed fever which is high grade, intermittent, associated with chills and rigor. He was in Orissa while he developed fever then he returned to his home 2 days later. He also had headache and generalised weakness since 1 week He developed vomitings since 3 days, 5 episodes, with food as content, non bilious, non projectile, not blood stained Loose stools since 3 days, 3 episodes/day, watery, green coloured, not blood stained. He went to a doctor outside but the symptoms didnot subside, then he came here on 7/6/23 H/o hematuria and green coloured stools since 3 days There is H/o taking papaya leaf juice for 3days in the morning before food  Past history  
READ MORE

Report Abuse yr old with pyrexia


26 yr old with pyrexia

June 12, 2023
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 



Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 



This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment


26 YR OLD MALE WITH FEVER SINCE I WEEK, VOMITINGS, LOOSE STOOLS SINCE 3 DAYS

Cheif complaints : 

26 year old male presented with cheif complaints of fever since 1 week

Generalised weakness and headache since 1 week

Vomitings since 3 days

Loose stools since 3 days

History of presenting illness:

Patient was apparently alright 1week ago then he developed fever which is high grade, intermittent, associated with chills and rigor.

He was in Orissa while he developed fever then he returned to his home 2 days later.He could not do his daily usaual work due to high grade fever and headache

He also had headache and generalised weakness since 1 week

Patient has fever with headache which is not associated with altered sensorium (meningitis -), not associated with photophobia, phonophobia(intra cranial injury -), diffuse headache (migrane -). 

He developed vomitings since 3 days, 5 episodes, with food as content, non bilious, non projectile, not blood stained

Loose stools since 3 days, 3 episodes/day, watery, green coloured, not blood stained.

He went to a doctor outside but the symptoms didnot subside, then he came here on 7/6/23

H/o hematuria and green coloured stools since 3 days

There is H/o taking papaya leaf juice for 3days in the morning before food 

Past history 

No H/o similar complaints in the past

Not a k/c/o DM, HTN, Thyroid disorders, epilepsy, asthma.

Personal history 

He has normal appetite, takes mixed diet, increased bowel movements, sleep is adequate.

He takes alcohol 2 quarters from 6 years 

On examination:

Patient is conscious, coherent and cooperative 

No pallor, clubbing, cyanosis, lymphadenopathy, pedal edema 












Vitals

Temp- 99.5F

PR- 86 bpm

RR- 20 cpm

BP- 100/70mmHg

Spo2 - 99% on RA



RS-B/L air entry present 

       NVBS

CVS- S1S2 present, no murmurs heard

PA- Soft,non tender

CNS: NAD



Investigations 

On 7/6/23

Hb: 14.9gm/dl

TLC: 900cells/cumm

RBC: 4.79 millions/cumm

PLATELETS: 50000 /cumm



Blood urea:52 mg/dl

Serum creatinine: 1.4 mg/dl


Serum Na+:139 mEq/L

Serum K+:4.0mEq/L

Serum Chloride:101 mEq/L


Bleeding time: 2min 30sec

Clotting time: 5min 00sec


PT: 20sec

INR: 1.4

APTT:41 sec



Stool for occult blood: Positive 


CUE

Albumin:+

Pus cells: 3-4/HPF

RBC: plenty


On 8/6/23

Hb: 13.3gm/dl

TLC: 900cells/cumm

Platelets: 50000 /cumm

RBC: 4.17million/cumm



Peripheral smear

RBC: Normocytic normochromic

WBC: counts decreased on smear

Platelet: counts decreased on smear




On 9/6/23

Hb: 12 gm/dl

TLC: 1300cells/cumm

RBC:3.78million/cumm

Platelets: 90,000/cumm

PCV: 35.4vol%


Serum creatinine:0.9mg/dl

Serum Na+ :139mEq/L

Serum K+: 4 mEq/L

Serum Chloride: 101mEq/L



APTT:43 Sec

PT: 22Sec

INR:1.62



Total Bilirubin: 4.93 mg/dl

Direct bilirubin: 3.46mg/dl

SGOT: 50 IU/L

SGPT: 18IU/L

Total proteins 5.0gm/dl

Albumin: 2.44gm/dl

A/G ratio: 0.95



On 10/6/23


Total Bilirubin: 2.37 mg/dl

Direct bilirubin: 1.99 mg/dl

SGOT: 79 IU/L

SGPT: 25 IU/L

Total proteins 4.5 gm/dl

Albumin: 1.69 gm/dl

A/G ratio: 0.58


Hb: 11.5 gm/dl

TLC: 1100 cells/cumm

RBC:3.63 million/cumm

Platelets: 62,000/cumm

PCV: 34.2 vol%


On 11/6/23


Total Bilirubin: 1.57 mg/dl

Direct bilirubin: 0.65 mg/dl

SGOT: 64 IU/L

SGPT: 30 IU/L

Total proteins 4.6 gm/dl

Albumin: 2.21 gm/dl

A/G ratio: 0.92


Hb: 11.3 gm/dl

TLC: 2000 cells/cumm

RBC: 3.58 million/cumm

Platelets: 70,000/cumm

PCV: 34 vol%


On 12/6/23


Hb: 11.6 gm/dl

TLC: 2400 cells/cumm

RBC: 3.66 million/cumm

Platelets: 80000/cumm

PCV: 35.2 vol%


Total Bilirubin: 1.17 mg/dl

Direct bilirubin: 0.23 mg/dl

SGOT: 62 IU/L

SGPT: 49 IU/L

Total proteins 6.2 gm/dl

Albumin: 3.3 gm/dl

A/G ratio: 1.74


Serum electrolytes 

Serum Na+ :140mEq/L

Serum K+: 4mEq/L

Serum Chloride: 100mEq/L

Differential diagnosis

Salmonella typhi? , E. Coli?, Entameoba hystalytica?, malaria? 


Diagnosis:

Pyrexia with pancytopenia


Treatment:

1.IV FLUIDS NS, DNS, RL@ 125 ml/hr  

2.Tab.DOLO 650mg PO/TID

3.Inj.NEOMOL 1gm IV/SOS (if temp>102F)

4.Monitor vitals


Popular posts from this blog

R.sriharsha ;reg no:1701006146

January 01, 2023
Image
CASE : CHIEF COMPLAINTS : A 64yr old male Patient came to casuality with chief complaints of  - unable to talk since 4 days - hiccups since 7 days - bowel and bladder incontinence, loss of appetite since 3 days  - loose stools 5 days back relieved on medication  - fever 4 days back  HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 7 days back , he then developed hiccups , loss of speech - 5 days back he developed diarrhoea 5 episodes/ day , for one day which was relieved on medication  -loss of appetite since 3 days , since one day he is unable to talk   - No H/O SOB , cough , palpitations - No H/O loss of consciousness , giddiness , involuntary passage of urine and stools . PAST HISTORY : h/o panic attack one month back secondary to family issues  - K/C/O DM2 since 2 yrs , on medication ,  -tab Metformin OD , tab Glimiperide OD - Not a K/C/O HTN, TB, Asthma, epilepsy, CAD, CVD PERSONAL HISTORY: Appetite - lost Diet - Mixed  Sleep - adequate Bowel and bladder movemen
READ MORE

1701006146 prefinal case

June 12, 2023
Image
26 YR OLD MALE WITH FEVER SINCE I WEEK, VOMITINGS, LOOSE STOOLS SINCE 3 DAYS Cheif complaints  26 year old male came with c/o Fever since 1 week c/o generalised weakness and headache since 1 week c/o vomitings since 3 days c/o loose stools since 3 days History of presenting illness : Patient was apparently alright 1week ago then he developed fever which is high grade, intermittent, associated with chills and rigor. He was in Orissa while he developed fever then he returned to his home 2 days later. He also had headache and generalised weakness since 1 week He developed vomitings since 3 days, 5 episodes, with food as content, non bilious, non projectile, not blood stained Loose stools since 3 days, 3 episodes/day, watery, green coloured, not blood stained. He went to a doctor outside but the symptoms didnot subside, then he came here on 7/6/23 H/o hematuria and green coloured stools since 3 days There is H/o taking papaya leaf juice for 3days in the morning before food  Past history  
READ MORE
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 



Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 



This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment


26 YR OLD MALE WITH FEVER SINCE I WEEK, VOMITINGS, LOOSE STOOLS SINCE 3 DAYS

Cheif complaints : 

26 year old male presented with cheif complaints of fever since 1 week

Generalised weakness and headache since 1 week

Vomitings since 3 days

Loose stools since 3 days

History of presenting illness:

Patient was apparently alright 1week ago then he developed fever which is high grade, intermittent, associated with chills and rigor.

He was in Orissa while he developed fever then he returned to his home 2 days later.He could not do his daily usaual work due to high grade fever and headache

He also had headache and generalised weakness since 1 week

Patient has fever with headache which is not associated with altered sensorium (meningitis -), not associated with photophobia, phonophobia(intra cranial injury -), diffuse headache (migrane -). 

He developed vomitings since 3 days, 5 episodes, with food as content, non bilious, non projectile, not blood stained

Loose stools since 3 days, 3 episodes/day, watery, green coloured, not blood stained.

He went to a doctor outside but the symptoms didnot subside, then he came here on 7/6/23

H/o hematuria and green coloured stools since 3 days

There is H/o taking papaya leaf juice for 3days in the morning before food 

Past history 

No H/o similar complaints in the past

Not a k/c/o DM, HTN, Thyroid disorders, epilepsy, asthma.

Personal history 

He has normal appetite, takes mixed diet, increased bowel movements, sleep is adequate.

He takes alcohol 2 quarters from 6 years 

On examination:

Patient is conscious, coherent and cooperative 

No pallor, clubbing, cyanosis, lymphadenopathy, pedal edema 












Vitals

Temp- 99.5F

PR- 86 bpm

RR- 20 cpm

BP- 100/70mmHg

Spo2 - 99% on RA



RS-B/L air entry present 

       NVBS

CVS- S1S2 present, no murmurs heard

PA- Soft,non tender

CNS: NAD



Investigations 

On 7/6/23

Hb: 14.9gm/dl

TLC: 900cells/cumm

RBC: 4.79 millions/cumm

PLATELETS: 50000 /cumm



Blood urea:52 mg/dl

Serum creatinine: 1.4 mg/dl


Serum Na+:139 mEq/L

Serum K+:4.0mEq/L

Serum Chloride:101 mEq/L


Bleeding time: 2min 30sec

Clotting time: 5min 00sec


PT: 20sec

INR: 1.4

APTT:41 sec



Stool for occult blood: Positive 


CUE

Albumin:+

Pus cells: 3-4/HPF

RBC: plenty


On 8/6/23

Hb: 13.3gm/dl

TLC: 900cells/cumm

Platelets: 50000 /cumm

RBC: 4.17million/cumm



Peripheral smear

RBC: Normocytic normochromic

WBC: counts decreased on smear

Platelet: counts decreased on smear




On 9/6/23

Hb: 12 gm/dl

TLC: 1300cells/cumm

RBC:3.78million/cumm

Platelets: 90,000/cumm

PCV: 35.4vol%


Serum creatinine:0.9mg/dl

Serum Na+ :139mEq/L

Serum K+: 4 mEq/L

Serum Chloride: 101mEq/L



APTT:43 Sec

PT: 22Sec

INR:1.62



Total Bilirubin: 4.93 mg/dl

Direct bilirubin: 3.46mg/dl

SGOT: 50 IU/L

SGPT: 18IU/L

Total proteins 5.0gm/dl

Albumin: 2.44gm/dl

A/G ratio: 0.95



On 10/6/23


Total Bilirubin: 2.37 mg/dl

Direct bilirubin: 1.99 mg/dl

SGOT: 79 IU/L

SGPT: 25 IU/L

Total proteins 4.5 gm/dl

Albumin: 1.69 gm/dl

A/G ratio: 0.58


Hb: 11.5 gm/dl

TLC: 1100 cells/cumm

RBC:3.63 million/cumm

Platelets: 62,000/cumm

PCV: 34.2 vol%


On 11/6/23


Total Bilirubin: 1.57 mg/dl

Direct bilirubin: 0.65 mg/dl

SGOT: 64 IU/L

SGPT: 30 IU/L

Total proteins 4.6 gm/dl

Albumin: 2.21 gm/dl

A/G ratio: 0.92


Hb: 11.3 gm/dl

TLC: 2000 cells/cumm

RBC: 3.58 million/cumm

Platelets: 70,000/cumm

PCV: 34 vol%


On 12/6/23


Hb: 11.6 gm/dl

TLC: 2400 cells/cumm

RBC: 3.66 million/cumm

Platelets: 80000/cumm

PCV: 35.2 vol%


Total Bilirubin: 1.17 mg/dl

Direct bilirubin: 0.23 mg/dl

SGOT: 62 IU/L

SGPT: 49 IU/L

Total proteins 6.2 gm/dl

Albumin: 3.3 gm/dl

A/G ratio: 1.74


Serum electrolytes 

Serum Na+ :140mEq/L

Serum K+: 4mEq/L

Serum Chloride: 100mEq/L

Differential diagnosis

Salmonella typhi? , E. Coli?, Entameoba hystalytica?, malaria? 


Diagnosis:

Pyrexia with pancytopenia


Treatment:

1.IV FLUIDS NS, DNS, RL@ 125 ml/hr  

2.Tab.DOLO 650mg PO/TID

3.Inj.NEOMOL 1gm IV/SOS (if temp>102F)

4.Monitor vitals


Popular posts from this blog

R.sriharsha ;reg no:1701006146

January 01, 2023
Image
CASE : CHIEF COMPLAINTS : A 64yr old male Patient came to casuality with chief complaints of  - unable to talk since 4 days - hiccups since 7 days - bowel and bladder incontinence, loss of appetite since 3 days  - loose stools 5 days back relieved on medication  - fever 4 days back  HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 7 days back , he then developed hiccups , loss of speech - 5 days back he developed diarrhoea 5 episodes/ day , for one day which was relieved on medication  -loss of appetite since 3 days , since one day he is unable to talk   - No H/O SOB , cough , palpitations - No H/O loss of consciousness , giddiness , involuntary passage of urine and stools . PAST HISTORY : h/o panic attack one month back secondary to family issues  - K/C/O DM2 since 2 yrs , on medication ,  -tab Metformin OD , tab Glimiperide OD - Not a K/C/O HTN, TB, Asthma, epilepsy, CAD, CVD PERSONAL HISTORY: Appetite - lost Diet - Mixed  Sleep - adequate Bowel and bladder movemen
READ MORE

1701006146 prefinal case

June 12, 2023
Image
26 YR OLD MALE WITH FEVER SINCE I WEEK, VOMITINGS, LOOSE STOOLS SINCE 3 DAYS Cheif complaints  26 year old male came with c/o Fever since 1 week c/o generalised weakness and headache since 1 week c/o vomitings since 3 days c/o loose stools since 3 days History of presenting illness : Patient was apparently alright 1week ago then he developed fever which is high grade, intermittent, associated with chills and rigor. He was in Orissa while he developed fever then he returned to his home 2 days later. He also had headache and generalised weakness since 1 week He developed vomitings since 3 days, 5 episodes, with food as content, non bilious, non projectile, not blood stained Loose stools since 3 days, 3 episodes/day, watery, green coloured, not blood stained. He went to a doctor outside but the symptoms didnot subside, then he came here on 7/6/23 H/o hematuria and green coloured stools since 3 days There is H/o taking papaya leaf juice for 3days in the morning before food  Past history  
READ MORE

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