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

 

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

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

18 th dec 

 19 th dec 

 

22 nd

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