Hello everyone, I'm a medicine intern and recently started my medical posting.This is a blog to share my experience and cases I came across during this period.

A 46yr old female, labourer by occupation resident of suryapet came to hospital with complaints of fever 20 days back- High grade, sudden in onset, intermittent type associated with nausea
vomitings 1-2 episodes/day non projectile, bilious and food particles as contents. History of loose stools 2-3 episodes only on one day- foul smelling, no blood and mucus in stools.

       

        Patient was apparently asymptomatic 6yrs back. Later she developed generalised weakness and giddiness for which she was taken to hospital and diagnosed with diabetes mellitus and on glimi M1 initially and converted to glimi M2 3yrs later. History of one episode of asthma 3yrs back for which she used inhaler. Since 1yr she developed left knee pain for which she is using unknown medication regularly. 6 months back she had an episode of giddiness for which she went to the doctor who monitored her BP for 3 days and prescribed anti hypertensive drugs- amlodipine 5 mg and atenolol 50mg.

Past medical history:

   K/c/o DM since 5-6yrs on regular medication- glimi M2

   K/c/o hypertension since 6 months on regular medication amlokind AT 5/50 mg.

    K/c/o hypothyroidism since 3yrs. She used thyronorm 25 for 2yrs and discontinued later.

     Not a k/c/o seizures, TB, CAD, CKD. 

Past surgical history:

     Hysterectomy 24yrs back.

Personal history: 

      She has decreased appetite since 20 days. Regular bowel and bladder habits. 

Addictions: 1 glass of toddy since 20yrs. Abstinence since 5yrs.

On examination: 

Patient is conscious, coherent, cooperative.

Pallor present. No icterus, cyanosis, clubbing, koilonychia, lymphadenopathy and pedal edema.

Vitals:

Temp: Afebrile 

PR: 90bpm

BP: 140/90 mm Hg

RR: 22cpm

SpO2: 96% at RA

CVS: S1 S2 heard, no murmurs.

RS: BAE present, NVBS heard.

PA: soft, mild tenderness present in epigastrium and right hypochondrium, bowel sounds heard.

CNS: No focal neurological deficits. 

  

Fundoscopy:

Investigations: 

Hemogram:

Day1:

Day2:

Peripheral smear: Microcytic hypochromic anaemia with leucocytosis

CUE: Albumin 1+   pus cells 5-6    RBC 2-3

RBS: 218mg/dl

FBS: 172mg/dl

PLBS: 284mg/dl

HbA1c: 7%

RFT:

USG abdomen: B/L grade 1 RPD changes.

 Altered echotexture of right kidney with few hypoechoic areas.

?Pyelonephritis.

CXR: normal

ECG:Normal

2D echo: 

https://photos.app.goo.gl/EpxgXfZp3zE7Tzt36

Provisional diagnosis:

46yrs female with fever and vomitings with k/c/o DM and HTN.

Treatment given:

IVF- 2 units NS at 100ml/hr, 1 unit RL

Inj ceftriaxone 1gm IV BD

Inj metrogyl 500mg IV TID

Inj Optineuron 1amp in 100ml NS IV BD

Inj pantop 40mg IV BD

Inj zofer 4mg IV BD

Inj HAI SC TID

BP/PR charting 

GRBS charting 6th hrly 

Tab PCM 650mg PO SOSj

Tab amlong/ atenolol (5/50) OD