50M Hypoalbuminemia Viral thrombocytopenia comorbidities Diabetes 10 yrs CAD CCF

 

Came to the opd with cheif complaints of

fever since 3 days and 

body pain since 3 days , 

sob since 1 day 

c/o FEVER SINCE 3 DAYS

C/O BODY PAINS SINCE 3 DAYS

C/O SOB SINCE 1 DAY

PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN HE DEVELOPED FEVER

SINCE 3 DAYS HIGH GRADE FEVER CHILLS+ CONTINOUS TYPE INSIDIOUS ONSET

GRADUALLY PROGRESSIVE NO AGGREVATING AND RELIEVING FACTORS ASSOCIATE WITH

BODY PAINS AND GENERALISED WEAKNESS ASSOCIATED WITH SHORTNESS OF BREATH

SINCE 1 DAY GRADE II NO H/O COUGH NO H/O CHEST PAIN PALPITATIONS

OUTSIDE REPORTS PLATELETS 13000

K/C/O DM II SINCE 10 YRS ON TAB GLIMI MI PO OD

K/C/O HTN SINCE 1 YEAR ON TAB METXL 50 MG PO OD

H/O EYE SX RIGHT EYE CATARAC

OUTSIDE REPORT platelet 13000

DM II SINCE 10 YR AND ON TAB GLIMI MI

AND HTN SINCE 1 YR ON TAB METEXL 50MG

 

 

                             SEQUENCE OF EVENTS

IS FARMER BY OCCUPATION

10 YR BACK HE HAD GIDDINESS  HE WENT TO HOSPTIAL AND DIAGNOSED WITH DIABETES  

13 MONTHS BACK THEN HE DEVELOPED DECREASED VISON IN RIGHT EYE AND HE UNDERWENT CATARACT OPERATION 12 MONTHS BACK                  

FEVER SINCE 2 DAYS AND BODY PAINS

 HE WENT TO RMP AT NAKREKAL  AND GOT A  TREATMENT AND HE TOLD TO GO TO                            KIMS DUE TO DECREASED PLATLETS   

HE HAD STARTED SOB AND CHILLS ON 18/1/24

2D ECHO

NO RWMA

MILD MR MODERATE AR MODERATE TR WITH PAH

SCLEROTIC AV NO AS/MS

EF 58 RVSP 42+12= 52MMHG

GOOD LV SYSTOLIC FUNCTION

NO DIASTOLIS DYSFUNTION

IVC SIZE (1.72CM ) DIALATED NON COLLAPSING

DIALATED LV

MILD DILATED RA /RV

x ray chest reporting

 

AIR OPACITIES IN BL LUMG FIELDS

DD PULMONARY EDEMA AND INFECTIVE CONSOLIDATION

OBSTRUCTION OF LEFT SOSTOPHRENIC ANGLE

DIAGNOSIS 

 

HYPOXIC ISHEMIC ENCEOHALOPATHY

ACYTE PULMONARY EDEMA ( CARDIOGENIC AND NON CARDIOGENIC )

HEARTFAILURE WITH PRESERVED EJECTION FRACTION 52%

MODERATE PULMONARY ARTERY HYPERTENSION

VIRAL PYREXIA WITH THROMBOCYTOPENIA

MULTIORGAN DYSFUNCTION ACUTE KIDNEY INJURY WITH ACUTE LIVER INJURY

GRADE 1 BED SORE

TYPE 2 DM AND HTN

S/P 5 SESSIONS OF HEMODIALYSIS

POST CRP STATUS ROSC ACHIEVE 2 TIMES

    TREATMENT :

 

RYLES TUBE FEEDS 200 ML MILK 4TH HRLY100ML WATER 2ND HRLY

INJ MIDAZOLAM

FENTANYL 30 ML + 4ML+16ML NS IV INFUSION 10ML/HR

INJ POPAMINE 6 ML/HR

INJNORADRENALINE IV INFUSION 4 ML /HR

INJ LEVOFLAXACIN 500ML/IV/0D 6DAYS

INJMEROPENEM 500ML /IV/BD

INJ CLINDAMYCIN 600ML /IV/BD

INJ PAN 40 MG IV ODINJ HAI SC TID

INJ HEPARIN 5000 UNITS IV OD 8 AM

INJ NEOMOL IGM IV SOS

INJ LASIX 100 ML IV INFUSION

TAB SINDENAFIL 20 mg po tid

NEB IPRAVENT BUTECORT 6TH HOURLY AnD MUCOMIST 8 TH HOURLY

TAB DOLO650 PO SOS