PATIENT CAME TO CASUALTY WITH CHIEF COMPLAINTS OF FEVER, AND GENERALISED WEAKNESS

 Case history and clinical findings:-

PATIENT CAME TO CASUALTY WITH CHIEF COMPLAINTS OF FEVER-HIGH GRADE SINCE 3 DAYS AND GENERALISED WEAKNESS SINCE 2 DAYS. PATIENT WAS APPARENTLY ASYMTOMATIC 3 DAYS BACK THEN HE DEVELOPED HIGH GRADE FEVER, INTERMITTENT TYPE, RELIEVED ON MEDICATION THEN HE DEVELOPED GENERALISED WEAKNESS SINCE 2 DAYS,PATIENT IS UNABLE TO DO ROUTINE ACTIVITIES SINCE 1 DAY. 

H/O TRAVELLING UNDER THE SUN FOR 2 DAYS. 

H/O GIDDINESS SINCE YESTERDAY,H/O FALL 2 TIMES, H/O LOSS OF CONCIOUSNESS FOR 5 MINS NO H/O SOB, CHEST PAIN,PALPITATIONS NO H/O VOMITING,DIAHRRHEA 

PAST HISTORY: K/C/O DM 2 SINCE 20 YEARS

H/O LEFT LOWER LIMB AND SCROTAL FILARIASIS SINCE 30 YEARS

 N/K/C/O HTN,ASTHMA,CAD,CVA,THYROID DISORDERS,TB

 PT IS C/C/C NO PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMPHADENOPATHY , EDEMA VITALS : TEMP :102 F PR: 116BPM RR: 26CPM BP: 140/80 MMHG

 SPO2 : 98 AT RA 

SYSTEMIC EXAMINATION: CVS : S1 S2 HEARD , NO ADDED MURMURS RS: BAE + , NVBS + . 

BILATERAL CREPTS HEARD P/A: SOFT , NON TENDER CNS - NO FND ENT REFERRAL WAS TAKEN IN VIEW OF DYSPHAGIA SINCE 1 DAY


PROVISIONAL Diagnosis

 PYREXIA SECONDARY TO ?TYPHOID FEVER 

ACUTE INFARCT IN RIGHT FRONTAL LOBE(PARASAGGITAL CORTEX-ACA TERRITORY) HBSAG POSITIVE 

DENOVO K/C/O DM 2 SINCE 20 YEARS 

CHRONIC KIDNEY DISEASE DISEASE STAGE 3A



Investigation 

URINE FOR CULTURE AND SENSITIVITY - NO PUSS CELLS SEEN , NO GROWTH

 USG ABDOMEN: RT KIDNEY 9.7 X 4.4 CM NORMAL S/E,CMD+ , PCS NORMAL LEFT KIDNEY 7.2X2.6 CM DECREASED S/INCREASED E , CMD PARTIALLY LOST, PCS NORMAL

FINDINGS: E/O FOCAL CALYCETASIS IN LOWER POLE OF RIGHT KIDNEY E/O 15X14MM CYST NOTED IN UPPER POLE OF LEFT KIDNEY IMPRESSION -GRADE 1 RPD CHANGES IN LEFT KIDNEY LEFT SIMPLE RENAL CORTICAL CYST FOCAL CALYCETASIS IN LOWER POLE OF RIGHT KIDNEY 2D ECHO- EF 58% TRIVIAL TR+ , NO MR /AR, NO RWMA , NO AS/MS GOOD LV SYSTOLIC FUNCTION DIASTOLIC DYSFUNCTION PRESENT ,NO PAH OR PE


Treatment Given(Enter only Generic Name)

 2%BETADINE GARGLES 5ML DILUTED IN GLASS OF WATER 3-4 TIMES A DAY PLENTY OF ORAL FLUIDS,PROPER HYDRATION GENERAL SURGERY REFERRAL WAS TAKEN I/V/O ELEPHANTIASIS OF LEFT LOWER LIMB SINCE 30 YEARS NO ACTIVE INTERVENSION FROM THEIR SIDE OPTHALMOLOGY REFERRAL WAS TAKEN I/V/O DIABETIC RETINOPATHY AND RAISED ICT FEATURES PUPILS ARE NOT FULLY DILATED , FUNDOSCOPY COULD NOT BE PERFORMED

 INJ.MONOCEF 1 GM IV/BD

 INJ.DOXYCYCLINE 200MG IV/BD

 IV FLUIDS NS@100ML/HR 

INJ NEOMOL 1GM IV SOS 

TAB.DOLO 650MG PO/TID 

INJ HAI ACCORDING TO GRBS 


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