60 YEAR OLD MALE PATIENT WITH C/O FEVER SINCE 1 WEEK

60 Year old male patient with c/o Fever since 1 week

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C/o FEVER SINCE 1 WEEK

BLOOD IN COUGH SINCE TODAY MORNING.

PATIENT WAS APPARENTLY ASYMPTOMATIC 20 YEARS BACK THEN HE HAD LOW GRADE FEVER,INSIDIOUS ONSET ASSOCIATED WITH COUGH AND SPUTUM ,WHITISH COLOUR, ODOURLESS WENT TO LOCAL HOSPITAL AND DIAGNOSED AS "SPUTUM POSITIVE TB" AND ISED ATT FOR 1 YERA. THEN STOOPED AFTER 1 YEAR.

NOW SINCE 1 WEEK PATIENT HAD COMPLAINTS OF FEVER HIGHGRADE ASSOCIATED WITH CHILLS AND LOSS OF APPETITE, A/W BLOOD IN COUGH SINCE TODAY MORNING.

NOH/O NECK STIFFNESS, NO NAUSEA,VOMITINGS AND LOOSE ATOOLS

NO H/O BURNING MICTURION.

PAST HISTORY:

K/C/O - TB 20 YEARS BACK, USED ATT FOR 1 YEAR 

N/K/C/O HTN,DM,BA,CAD,CVA

PERSONAL HISTORY:

HE IS MARRIED, SHEPARD BY OCCUPATION,

APPETITE-LOST, NON VEGETARIAN, NO KNOWN ALLERGIES

REGULAR ALCOHOLIC-90ML WHISKY SINCE 40 YEARS.

CHRONIC SMOKER- 15 BEEDIS/DAY SINCE 40 YEARS.

GENERAL EXAMINATION: 

PATIENT IS C/C/C 

NO PALLOR,ICTERUS,CLUBBING,CYANOSIS,LYMPHADENOPATHY,OEDEMA OF FEET.

VITALS: AFEBRILE, PR-80/MIN.   RR-16/MIN.   BP-110/80.  SPO2- 98%. GRBS-140

INVESTIGATIONS- 

ECG,

USG ABDOMEN: 

(1) RAISED ECHOGENICITY OF B/L KIDNEY CORELATE WITH RFT's

(2) REVIEW ON FASTING STATE TO r/O GALL BLADDER PATHOLOGY.

DIAGNOSIS:

VIRAL PYEEXIA WITH THROMBOCYTOPENIA SECONDARY TO DENGUE NS+VE WITH K/C/O PULMONARY KOCHS 20 YEARS BACK, USED ATT FOR 1 YEAR COMPLETELY.

TREATMENT GIVEN: 

(1) IVF NS,RL @100 ml/hr

(2) INJ.PAN 40 MG IV /OF

(3) INJ.OPTINEURON 1 AMP IN 100 ML NS /IV/OD

(4) INJ.NEOMOL 1 GM/IV/SOS

(5) TAB.PCM 650 MG /PO/SOS

(6) NEBULIZATION WITH DULIN-8TH HOURLY, BUDECORT-12TH HOURLY

(7) W/F BLEEDING MANIFESTATIONS.

ADVICE AT DISCHARGE:

(1) PLENTY OF ORAL FLUIDS(4-5 L/DAY)

(2) TAB.PCM 650 MG PO/ SOS

(3). TAB.ZINCOVIT PO/OD FOR 1 WEEK

(4)WATCH FOR ANY BLEEDING MANIFESTATIONS

(5) REPEAT HAEMOGRAM AFTER 2 DAYS, IF THERE IS ANY DECREASED IN OLATELET COUNT, KINDLY VISIT TO OPD 

REVIEW AFTER 1 WEEK