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A 40 YR OLD MALE

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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