Unit 6 admission
A 48 yr old male, farmer by occupation & resident of Nakrekal.came to casualty with
CHEIF COMPLAINTS:
1.Fever since 1wk
2.Swelling in the right lower limb since 4 days
3.Pain over the swelling since 2 days
4.Loose stools since 4 days (4 episodes/day)
HISTORY OF PRESENT ILLNESS :
pt was apparently asymptomatic 1 wk back then, he developed
1. FEVER :
- low grade, intermittent type, associated with chills & rigors & relieved by medications.
- pt is k/c/o Rt lower limb filariasis since 20 yrs
- Due to filariasis, pt used to have fever spikes for every 6 months since 20 yrs. for which he used to take medications & fever relieved
- Recently After 3 yrs, he again had a bout of fever spikes since 1 wk.for which he got admitted to a local hospital in nakrekal and took medications. & also found decrease of platelet count
2. SWELLING IN THE RIGHT LOWER LIMB :
- pt had trauma over rt lower limb 4 dys back, after which pt noticed swelling over rt lower limb
- As pt is a k/c/o of filariasis.he had swelling over the rt lower limb since 20 yrs .in which swelling aggravated with fever spikes for every 6 months & relieved with medications
- Recently swelling appeared after 3 yrs with fever spikes since 1 wk
- Along with that, his trauma which occured 4 days back. increased his swelling over rt leg shin area leading to pent up of swelling
Swelling
Onset : Insidious
Duration : 4days
Progression : gradual
Aggravating factors : rest
Relieving factors : walking
- no discharge, no sinuses present
3. PAIN OVER THE SWELLING :
- initially painless then after 2 days, pt developed pain over the swelling
- pain - pricking type
NEGATIVE HISTORY: No body pains, abdominal pain, head ache, vomitings
PAST HISTORY:
- No similar complaints in the past
-n/k/c/o DM,HTN, Asthma, TB, Epilepsy
FAMILY HISTORY - no significant family history
PERSONAL HISTORY-
- Diet - mixed
- Appetite - normal
- Sleep- adequate
- Bowel & Bladder movements - increased
- Addictions - Absent
GENERAL EXAMINATION:
Patient is conscious, coherent, cooperative.
- No pallor
- No icterus
- No clubbing, cyanosis
- No koilonychia
- No lymphadenopathy
- No Edema
- No rashes, Petechiae & Bleeding manifestations
-Tourniquet test - Negative
VITALS :
1.Temperature : Afebrile
2. BP : 100/70mmHg
3. PR : 74 bpm
4. RR :
SYSTEMIC EXAMINATION :
PER ABDOMEN:
- No distended abdomen
- No abdominal tenderness
- No engorged veins
- Guarding & rigidity absent
RESPIRATORY SYSTEM:
BAE+
NVBS
CVS :
S1S2 HEARD
no thrills no murmurs
CNS:
All superficial and deep reflexes are normal
PROVISIONAL DIAGNOSIS :
- Dengue NS 1 antigen positive suggestive of Dengue with Rt lower limb filariasis
FEVER CHARTING :
SURGERY REFERRAL:
INVESTIGATIONS :
HEMOGRAM:
- 5 days back
- TOTAL WBC COUNT - 5,250 cells/cumm ( N - 4,000 to 10,000 cells/cumm)
- PLATELET COUNT - 1.99 lakhs/cumm ( N - 1.5 - 4.1 lakh/cumm)
- PCV - 38.3% ( N - 40 - 50 %)
- 3 days back
- TOTAL WBC COUNT - 3,500 cells/cumm
- PLATELET COUNT - 1.25 lakhs/cumm
- PCV - 46%
- 2 days back
TOTAL WBC COUNT - 2,150 cells/cumm
- PLATELET COUNT - 44,000 cells/cumm
- PCV - 39%
- 1 day back (MORNING)
- TOTAL WBC COUNT - 3,650 cells/cumm
- PLATELET COUNT - 39,000 cells/cumm
- PCV - 39.4%
- 1 day back (EVENING)
- TOTAL WBC COUNT - 4,200 cells/cumm
- PLATELET COUNT - 60,000 lakhs/cumm
- PCV - 39.1%
- Today (Morning)
Evening
DENGUE RAPID TEST
MALARIAL PARASITE TEST
LFT
CUE
RBS
BLOOD UREA
SERUM CREATININE
SERUM ELECTROLYTES
ECG
TREATMENT
DATE - 08/08/21
1. IVF @ 75 Ml/hr
- 1. NS
- 1. RL
- 1. DNS
2. TAB PCM 650 MG X PO X TID
1 - 1 - 1
Check temperature before giving pcm
3. TEMPERATURE CHARTING 4TH HRLY
4. GRBS CHARTING 6TH HRLY
5. I/O CHARTING
DATE - 9/09/21
1. IVF @ 75 Ml/hr
- 1. NS
- 1. RL
- 1. DNS
2. TAB PCM 650 MG X PO X TID
1 - 1 - 1
3. TAB AUGMENTIN 625 MG X OD X BD
4. TAB PAN 40 MG X OD
5. TAB MVT ORAL OD
6. TAB VIT C ORAL OD
7. TAB DOLO 650 MG ORAL (SOS)
8. Check temperature before giving pcm
9. TEMPERATURE CHARTING 4TH HRLY
10.GRBS CHARTING 6TH HRLY
11. I/O CHARTING
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