ENTERIC FEVER,DIABETES MELLITUS SINCE 9 YEARS, HYPERTENSION SINCE 1 WEEK WITH ANEMIA-MCHC SECONDARY TO NUTRITIONAL CAUSE
A 49 years old female who is a house wife by occupation came with C/O
FEVER SINCE 2 WEEKS
HOPI
Patient was apparently asymptomatic 9 years back then she started having bleeding per vagina for which she went to hospital & Diagnosed to have ? Fibroid uterus for which she went to a private hospital in hyderabad for hysterectomy as advised in local hospital. Then she had high sugars for the first time (Around 450mg/dl).So she was admitted in the hospital & hysterectomy was done after controlling the sugars with Insulin.
Then she was discharged with the following advice
Tab.GLIME M1 PO BD & continued the tablet for 3 years
Along with diabetic diet.
Then she came to our OP for Follow then she was prescribed with Tab.GLIME M2 PO BD which she used for 2 years. Then she came to our OP for Follow up then she was escalated to Tab.GLIME M3 PO BD.
March 2023 [1ST VISIT]
She had ulcer over left great toe for which she was admitted in our hospital & got relieved.
18th of November 2023 [ 2ND VISIT]
SHE HAD DEVELOPED SWELLING IN THE RIGHT FOOT EXTENDING UPTO MIDDLE OF THE LEG WHICH WAS INSIDIOUS IN ONSET,GRADUALLY PROGRESSIVE ,NO AGGREVATING AND RELIVING FACTORS.SWELLING WAS ASSOCIATED WITH PAIN , WHICH WAS DRAGGING TYPE , NON RADIATING , INTERMITTENT , AGGRAVATED ON WALKING , NO RELIEVING FACTORS .
H/O FEVER WAS PRESENT ON AND OFF RELIEVED ON TAKING MEDICATION
NO H/O TRAUMATIZED
SHE THEN CAME TO THIS HOSPITAL ON 16-11-2023 and WAS DIAGNOSED WITH CELLULITIS OF RIGHT LEG
THEN, PATIENT WAS ADMITTED, EVALUATED,AND WAS TREATED FOR 7 DAYS.
PAST HISTORY
K/C/O DIABETES MELLITUS SINCE 10 YEARS ON INJ HUMAN MIXTARD 30U-25U
NOT A K/C/O ASTHMA,COPD,HYPERTENSION,EPILEPSY,TUBERCULOSIS
H/O HYSTERECTOMY 30 YEARS AGO
GENERAL PHYSICAL EXAMINATION -
PT IS CONSCIOUS,COHERENT AND COOPERATIVE
No pallor
No icterus
No cyanosis
No clubbing
No lymphadenopathy
Pitting type of pedal edema is
present.
TEMP - AFEBRILE
BP - 130/70 MM OF HG
PR - 98BPM ,RR - 16 CPM
SPO2 - 99% @RA
CVS- S1,S2 HEARD , RS - B/L AE +
LOCAL EXAMINATION
INSPECTION :
SWELLING OF RIGHT LEG PREENT EXTENDING UPTO MIDDLE 1/3RD OF RT LEG
REDNESS PRESENT
NO SCARS,SINUSES,ENGORGED VEINS,VISIBLE PULSATIONS.
PALPATION
ALL INSPECTORY SIGNS ARE CONFIRMED
LOCAL RISE OF TEMPERATURE PRESENT
TENDERNESS PRESENT
PITTING TYPEOF EDEMA PRESENT EXTENDING UPTO MIDDLE 1/3RD OF THE LEG
PERIPHERAL PULSES PALPABLE
POST LUNCH BLOOD SUGAR 16-11-2023 110 mg/dl
SERUM CREATININE 16-11-2023 0.9
COMPLETE URINE EXAMINATION (CUE) 16-11-2023
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN ++
SUGAR +++
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-6
EPITHELIAL CELLS 2-4
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
ABG 16-11-2023
PH 7.47
PCO2 28.4
PO2 82.9
HCO3 20.5
St.HCO3 22.8
BEB -1.9
BEecf -2.6
TCO2 42.2
O2 Sat 96.9
O2 Count 13.6
COMPLETE URINE EXAMINATION (CUE) 16-11-2023
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN Nil
SUGAR ++++
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-4
EPITHELIAL CELLS 2-4
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
COMPLETE BLOOD PICTURE (CBP) 16-11-2023 10:33:PM
HAEMOGLOBIN 9.0 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 10800 cells/cumm 10000-4000 cells/cumm
NEUTROPHILS 62 % 80-40 %
LYMPHOCYTES 32 % 40-20 %
EOSINOPHILS 00 % 6-1 %
MONOCYTES 06 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 3.87
SMEAR microcytic hypochromic anemia
HBsAg-RAPID 16-11-2023 Negative
LIVER FUNCTION TEST (LFT) 16-11-2023
Total Bilurubin 0.51 mg/dl 1-0 mg/dl
Direct Bilurubin 0.20 mg/dl 0.2-0.0 mg/dl
SGOT(AST) 14 IU/L 31-0 IU/L
SGPT(ALT) 19 IU/L 34-0 IU/L
ALKALINE PHOSPHATE 143 IU/L 98-42 IU/L
TOTAL PROTEINS 6.4 gm/dl 8.3-6.4 gm/dl
ALBUMIN 3.91 gm/dl 5.2-3.5 gm/dl
A/G RATIO 1.57
RFT 16-11-2023 10:33:PM
UREA 18 mg/dl
CREATININE 0.7 mg/dl
URIC ACID 5.7 mg/dl
CALCIUM 10.1 mg/dl
PHOSPHOROUS 3.3 mg/dl
SODIUM 135 mEq/L
POTASSIUM 3.7 mEq/L
CHLORIDE 101 mEq/L 98-107 mEq/L
POST LUNCH BLOOD SUGAR 17-11-2023 393 mg/dl
RFT 19-11-2023
UREA 18 mg/dl
CREATININE 0.6 mg/dl
URIC ACID 2.6 mg/dl
CALCIUM 10.1 mg/dl
PHOSPHOROUS 3.4 mg/dl
SODIUM 137 mEq/L
POTASSIUM 4.2 mEq/L
CHLORIDE 102 mEq/L
COMPLETE BLOOD PICTURE (CBP) 20-11-2023
HAEMOGLOBIN 8.9 gm/dl
TOTAL COUNT 12200 cells/cumm
NEUTROPHILS 68 %
LYMPHOCYTES 26 %
EOSINOPHILS 00 %
MONOCYTES 06 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 4.33
SMEAR Microcytic hypochromic anemia with leukocytosis
FINAL DIAGNOSIS
CELLULITIS OF RIGHT LEG
Treatment Given
DIABETIC DIET
INJ AUGMENTIN 1.2 G IV BD
TAB PAN 40MG PO OD BBF
TAB CHYMORAL FORTE PO TID
INJ METROGYL 500MG IV TID
TAB ULTACET PO BD
TAB MVT PO OD
TAB VITAMIN C PO OD
ADEQUATE GLUCOSE CONTROL
RIGHT LOWER LIMB ELEVATION
REGULAR MAGNESIUM SULPHATE AND GLYCERINE DRESSINGS
DATE OF DISCHARGE : 23/11/2023
THEN THE PATIENT WAS DISCHARGED ON 23/11/2023 WITH THE FOLLOWING ADVICE :
DIABETIC DIET
TAB.GLIMI M1 PO OD BBF
TAB.MVT PO OD FOR 1 WEEK
TAB.VITAMIN C PO OD FOR 1 WEEK
LIMB ELEVATION.
[5/1, 9:20 AM] Rakesh Biswas Sir GM HOD: @Narsimha Reddy sir Pg Gm You can see in meticulous detail how maximal dose of sulfonylurea titration actually brought her glucose values to ideal levels before the intern who was caring for her regularly and following her up abruptly left and she again slipped into hyperglycemia and sepsis with which we are still struggling in the last two admissions over last one month!
[5/1, 9:51 AM] Narsimha Reddy sir Pg Gm: Yes Sir there was a good control
With gradual uptitration of GLIMEPERIDE over those 22 days Span. Really appreciate the effort of the intern 👏. It was also clearly evident how a good diet can add up the Control.
[5/1, 9:52 AM] Narsimha Reddy Pg Gm: Hoping to switch back to OHAs
[5/1, 10:01 AM] Rakesh Biswas Sir GM HOD: Let's not attempt it again before we are sure of the PaJR care she's going to receive
[5/1, 11:56 AM] +91 hemant c sir: We shall take regular updates on their activities like food and medication to better understand the glucose control
18th OF APRIL , 2024 [ 3rd VISIT TO THIS HOSPITAL]
SHE HAD COMPLAINTS OF FEVER SINCE 13 DAYS A/W CHILLS ,MORE AT MORNING, RELIEVED WITH MEDICATION A/W PROFUSE SWEATING.
H/O INCREASED FREQUENCY OF LOOSE STOOLS ON AND OFF SINCE 2 MONTHS
NO H/O BURNING MICTURITION
NO H/O PAIN ABDOMEN , VOMITINGS
NO H/O CHEST PAIN, PALPITATIONS
NO H/O COLD,COUGH
NO H/O PEDAL EDEMA, DRUG NON-COMPLIANCE
HISTORY OF PAST ILLNESS :
K/C/O DM SINCE 8 YEARS ON
GLIMIPERIDE
N/K/C/O HTN ; THYROID DISORDERS , ASTHMA , TB , EPILEPSY , CAD , CVA
MENSTRUAL HISTORY :
HYSTERECTOMY DONE 9 YEARS AGO
Chest Xray on 18/04/24
USG Abdomen on 18/04/24 :
Insulin drip chart - 18/4/24
HBsAg-RAPID 18-04-2024 12:32:PM
Negative
COMPLETE URINE EXAMINATION (CUE) 18-04-2024 12:32:PM
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN Nil
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-4
EPITHELIAL CELLS 2-3
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
LIVER FUNCTION TEST (LFT) 18-04-2024 12:34:PM
Total Bilurubin 1.46 mg/dl 1-0 mg/dl
Direct Bilurubin 0.43 mg/dl 0.2-0.0 mg/dl
SGOT(AST) 10 IU/L 31-0 IU/L
SGPT(ALT) 10 IU/L 34-0 IU/L
ALKALINE PHOSPHATASE 232 IU/L 98-42 IU/L
TOTAL PROTEINS 7.0 gm/dl 8.3-6.4 gm/dl
ALBUMIN 3.67 gm/dl 5.2-3.5 gm/dl
A/G RATIO 1.10
RFT 18-04-2024 12:34:PM
UREA 37 mg/dl 42-12 mg/dl
CREATININE 1.3 mg/dl 1.1-0.6 mg/dl
URIC ACID 4.1 mmol/L 6-2.6 mmol/L
CALCIUM 9.6 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 3.6 mg/dl 4.5-2.5 mg/dl
SODIUM 136 mmol/L 145-136 mmol/L
POTASSIUM 4.6 mmol/L. 5.1-3.5 mmol/L.
CHLORIDE 98 mmol/L 98-107 mmol/L
POST LUNCH BLOOD SUGAR 18-04-2024 12:35:PM 493 mg/dl 140-0 mg/dl
PERIPHERAL SMEAR 18-04-2024 12:55:PM RBC : Microcytic hypochromic WBC :increased counts on smear PLATELET : Adequate
ABG 18-04-2024 03:42:PM
PH 7.41
PCO2 24.0
PO2 90.8
HCO3 15.2
St.HCO3 18.0
BEB -7.9
BEecf -8.4
TCO2 32.2
O2 Sat 96.6
O2 Count 11.8
ABG 18-04-2024 10:54:PM
PH 7.36
PCO2 31.7
PO2 39.7
HCO3 17.5
St.HCO3 18.6
BEB -6.8
BEecf -6.9
TCO2 38.1
O2 Sat 75.4
O2 Count 7.7
SERUM ELECTROLYTES (Na, K, C l) 18-04-2024 10:54:PM
SODIUM 128 mmol/L 145-136 mmol/L
POTASSIUM 3.8 mmol/L 5.1-3.5 mmol/L
CHLORIDE 104 mmol/L 98-107 mmol/L
SERUM ELECTROLYTES (Na, K, C l) 19-04-2024 11:54:AM
SODIUM 134 mmol/L 145-136 mmol/L
POTASSIUM 3.9 mmol/L 5.1-3.5 mmol/L
CHLORIDE 105 mmol/L 98-107 mmol/L
COMPLETE URINE EXAMINATION (CUE) 19-04-2024 11:54:AM
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN +
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 2-4
EPITHELIAL CELLS 2-3
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
ABG 19-04-2024 04:44:PM
PH 7.42
PCO2 28.7
PO2 73.8
HCO3 18.5
St.HCO3 20.5
BEB -4.7
BEecf -5.1
TCO2 39.1
O2 Sat 95.7
O2 Count 11.4
SERUM ELECTROLYTES (Na, K, C l) 19-04-2024 11:06:PM
SODIUM 137 mmol/L 145-136 mmol/L
POTASSIUM 4.0 mmol/L 5.1-3.5 mmol/L
CHLORIDE 105 mmol/L 98-107 mmol/L
HEMOGRAM 19/4/24
HB - 7.6
TLC-14,400
PCV - 22.8
RBC - 3.9
SMEAR - MICROCYTIC HYPOCHROMIC
HBA1C - 7.6 %
RETICULOCYTE COUNT - 0.9 %
URINE FOR KETONE BODIES - NEGATIVE
USG REPORT ;
IMPRESSION - NO SONOLOGICAL ABNORMALITY DETECTED
2D ECHO ;
IMPRESSION - NO RWMA
MODERATE TR + WITH MILD PAH ( ECCENTRIC TYPE
MILD AR + , TRIVIAL MR +
SCLEROTIC AV NO AS MS , IAS INTACT
MAC +
EF 61 %
RV SP2 38 + 10 = 48 MM HG
GOOD LV SYTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION - NO PE
IVC SIZE - 1.0 CM COLLAPSING
21/4/24 -
HB - 8 GM/DL
TLC-8000 CELLS/CUMM
PLATELETS -3.26LAKHS/CUMM
SMEAR -MICROCYTIC HYPOCHROMIC ANAEMIA
SERUM ELECTROLYTES -
SODIUM - 140 MMOL/L
POTASSIUM- 4.2 MMOL/L
CHLORIDE - 104 MMOL/L
CALCIUM IONISED - 1.16 MMOL/L
22/4/24 -
HB - 7.7 GM/DL
TLC-8500 CELLS/CUMM
PLATELETS -3.4 LAKHS/CUMM
PCV - 24.2 VOL%
MCV- 59.8 FL
MCH - 18.9 PG
RDW-CV - 15.5 %
SMEAR -MICROCYTIC HYPOCHROMIC ANAEMIA
SERUM ELECTROLYTES -
SODIUM - 143 MMOL/L
POTASSIUM- 4.3 MMOL/L
CHLORIDE - 106 MMOL/L
CALCIUM IONISED - 1.15 MMOL/L
URINE CULTURE -NO GROWTH
BLOOD CULTURE -ECOLI ISOLATED
SENSITIVE TO AMOXYCLAV, GENTAMICIN, COTRIMOXAZOLE, AMIKACIN, PIPERACILIN, TAZOBACTAM.
DIAGNOSIS
SHE THEN CAME TO THIS HOSPITAL ON 18-04-2024 and WAS DIAGNOSED WITH
1.ENTERIC FEVER
2.DIABETES MELLITUS TYPE II SINCE 9 YEARS WITH UNCONTROLLED SUGARS
3. IRON
DEFICIENCY ANEMIA SECONDARY TO NUTRITIONAL CAUSE
4. DENOVO HYPERTENSION
Treatment Given
IVF FUSIDEX(0.45% NS+ 5% DEXTROSE)
IVF NS @ 100ML / HR
INJ HAI 40U IN 39ML NS @6ML/HR INCREASE OR DECREASE ACC TO GRBS
INJ MONOCEF 1 GM IV BD X 5DAYS
INJ PAN 40 IV OD
INJ HAI S/C TID ACC TO GRBS
INJ NPH S/C BD ACC TO GRBS
INJ NEOMAL 1 GM IV SOS IF TEMP > 101 F
INJ.IRON SUCROSE 1AMP IN 100ML IN NS IV/OD 2 DOSES
T.PCM 650 MG PO TID 1-1-1
T.OROFER XT PO OD 1-0-0
T.PREGABALIN 75MG PO/SOS 0-0-1
T.CLONAZEPAM MD 0.5MG PO/SOS
IF ANXIOUS/RESTLESS
DISCHARGE
THEN, PATIENT WAS ADMITTED, EVALUATED,AND WAS TREATED FOR 6 DAYS.
DATE OF DISCHARGE : 24/04/2024
THEN THE PATIENT WAS DISCHARGED ON 24/04/2024 WITH THE FOLLOWING ADVICE :
INJ.HUMAN ACTRAPID INSULIN A/C TID 16U-16U-16U
INJ.NPH S/C BD 14U----X----14U
TAB.TELMA 20MG PO OD 1----X----X CONTINUE
TAB.PAN 40 IV OD FOR 5 DAYS
TAB.OROFER XT PO OD 1----0----0 FOR 30 DAYS
TAB.PREGABALIN 75 MG PO / SOS 0---0---1 FOR 1 WEEK
INJ.IRON SUCROSE 1 AMP IN 100ML IV ALTERNATE DAYS FOR
PLENTY OF ORAL FLUIDS
STRICT DIABETIC DIET
IRON RICH DIET
PaJR conversations in sequence
Narsimha reddy sir : vitals + GRBS [from 18/04/24 to 20/04/24 ( till 8 am )]
Narsimha reddy sir : Yesterday( i.e., 19/05/24)
8PM - 298 mg/dl - 8U HAI + 8U NPH
Had 2 Chapathi with Mixed Vegetable Curry
10PM - 331 mg/dl
20/05/24
2AM - 228 mg/dl
20/4/24 :..
8AM -224 mg/dl - 10U HAI + 10U NPH - Had 3 idly with Spice Powder
Rakesh Biswas sir: Please update the fever chart and share the image asap
FEVER CHART [from 18/04/24 to 22/04/24 (till 8 am) ]
GRBS CHART [ from 18/4/24 to 20/04/24 ( till 8 am ) ].....
28th OF APRIL, 2024 [ 4th VISIT TO THIS HOSPITAL]
IT WAS REALISED DURING HER 4th VISIT THAT SHE ALSO HAD URINARY TRACT INFECTION (UTI+) and THIS DIAGNOSIS WAS MISSED DURING HER 3RD VISIT and WAS ALSO NOT MENTIONED IN THE 3RD VISIT DISCHARGE SUMMARY, DATED 24-04-2024.
CHIEF COMPLAINTS: FEVER SINCE 2 WEEKS
HISTORY OF PRESENT ILLNESS : PATIENT WAS APPARENTLY ASYMPTOMATIC 2 WEEKS BACK AND THEN SHE DEVELOPED FEVER 2 WEEKS A/W CHILLS AND RIGORS ANS RELIEVED IN BETWEEN BUT SINCE TODAY MORNING THE FEVER IS PRESENT ,HIGH GRADE ,CONTINOUS TYPE A/W CHILLS AND RIGORS ,HEADACHE +,NO AGGRAVATING AND RELIEVING FACTORS
NO H/O BURNING MICTURATION
NO H/O PAIN ABDOMEN , VOMMITINGS
NO H/O CHEST PAIN , PALPITATIONS
NO H/O COLD , COUGH
NO H/O PEDAL EDEMA,DRUG NON COMPLIANCE
HISTORY OF PAST ILLNESS :
K/C/O DM SINCE 9 YEARS AND ON INJ HAI/SC/TID 16U-16U-16U
INJ NPH SC /BD 14U-X-14U
K/C/O HTN SINCE 6 DAYS AND ON TAB TELMA 20MG PO/OD
N/K/C/O THYROID DISORDERS , ASTHMA , TB , EPILEPSY , CAD , CVA
MENSTRUAL HISTORY :
HYSTERECTOMY DONE 9 YEARS AGO
ON EXAMINATION
Pt. Consent was taken.
Pt.was examined in a well lit room
PT IS CONSCIOUS, COHERENT,COOPERATIVE
No pallor
No icterus
No cyanosis
No clubbing
No lymphadenopathy
Pitting type of pedal edema is present.(??????)
Family history- Not significant
Personal history-
Diet- mixed
Appetite- normal
Bowel and bladder movements- normal
Sleep- inadequate
No addictions
VITALS:
TEMP-101 F
PULSE RATE 92 BPM
BP 140/90 MMHG
GRBS -256MG/DL
CVS-S1 S2 HEARD NO MURMURS
RS- BAE PRESENT NVB
P/A-SOFT,NON TENDER
Investigations in sequence from November 2023 to present today
November, 2023
POST LUNCH BLOOD SUGAR 16-11-2023 110 mg/dl
SERUM CREATININE 16-11-2023 0.9
COMPLETE URINE EXAMINATION (CUE) 16-11-2023
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN ++
SUGAR +++
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-6
EPITHELIAL CELLS 2-4
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
ABG 16-11-2023
PH 7.47
PCO2 28.4
PO2 82.9
HCO3 20.5
St.HCO3 22.8
BEB -1.9
BEecf -2.6
TCO2 42.2
O2 Sat 96.9
O2 Count 13.6
COMPLETE URINE EXAMINATION (CUE) 16-11-2023
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN Nil
SUGAR ++++
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-4
EPITHELIAL CELLS 2-4
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
COMPLETE BLOOD PICTURE (CBP) 16-11-2023 10:33:PM
HAEMOGLOBIN 9.0 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 10800 cells/cumm 10000-4000 cells/cumm
NEUTROPHILS 62 % 80-40 %
LYMPHOCYTES 32 % 40-20 %
EOSINOPHILS 00 % 6-1 %
MONOCYTES 06 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 3.87
SMEAR microcytic hypochromic anemia
HBsAg-RAPID 16-11-2023 Negative
LIVER FUNCTION TEST (LFT) 16-11-2023
Total Bilurubin 0.51 mg/dl 1-0 mg/dl
Direct Bilurubin 0.20 mg/dl 0.2-0.0 mg/dl
SGOT(AST) 14 IU/L 31-0 IU/L
SGPT(ALT) 19 IU/L 34-0 IU/L
ALKALINE PHOSPHATE 143 IU/L 98-42 IU/L
TOTAL PROTEINS 6.4 gm/dl 8.3-6.4 gm/dl
ALBUMIN 3.91 gm/dl 5.2-3.5 gm/dl
A/G RATIO 1.57
RFT 16-11-2023 10:33:PM
UREA 18 mg/dl
CREATININE 0.7 mg/dl
URIC ACID 5.7 mg/dl
CALCIUM 10.1 mg/dl
PHOSPHOROUS 3.3 mg/dl
SODIUM 135 mEq/L
POTASSIUM 3.7 mEq/L
CHLORIDE 101 mEq/L 98-107 mEq/L
POST LUNCH BLOOD SUGAR 17-11-2023 393 mg/dl
RFT 19-11-2023
UREA 18 mg/dl
CREATININE 0.6 mg/dl
URIC ACID 2.6 mg/dl
CALCIUM 10.1 mg/dl
PHOSPHOROUS 3.4 mg/dl
SODIUM 137 mEq/L
POTASSIUM 4.2 mEq/L
CHLORIDE 102 mEq/L
COMPLETE BLOOD PICTURE (CBP) 20-11-2023
HAEMOGLOBIN 8.9 gm/dl
TOTAL COUNT 12200 cells/cumm
NEUTROPHILS 68 %
LYMPHOCYTES 26 %
EOSINOPHILS 00 %
MONOCYTES 06 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 4.33
SMEAR Microcytic hypochromic anemia with leukocytosis
From 18-04-24 to 24-04-24
HBsAg-RAPID 18-04-2024
Negative
COMPLETE URINE EXAMINATION (CUE) 18-04-2024
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN Nil
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-4
EPITHELIAL CELLS 2-3
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
LIVER FUNCTION TEST (LFT) 18-04-2024
Total Bilurubin 1.46 mg/dl 1-0 mg/dl
Direct Bilurubin 0.43 mg/dl 0.2-0.0 mg/dl
SGOT(AST) 10 IU/L 31-0 IU/L
SGPT(ALT) 10 IU/L 34-0 IU/L
ALKALINE PHOSPHATASE 232 IU/L 98-42 IU/L
TOTAL PROTEINS 7.0 gm/dl 8.3-6.4 gm/dl
ALBUMIN 3.67 gm/dl 5.2-3.5 gm/dl
A/G RATIO 1.10
RFT 18-04-2024 12:34:PM
UREA 37 mg/dl 42-12 mg/dl
CREATININE 1.3 mg/dl 1.1-0.6 mg/dl
URIC ACID 4.1 mmol/L 6-2.6 mmol/L
CALCIUM 9.6 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 3.6 mg/dl 4.5-2.5 mg/dl
SODIUM 136 mmol/L 145-136 mmol/L
POTASSIUM 4.6 mmol/L. 5.1-3.5 mmol/L.
CHLORIDE 98 mmol/L 98-107 mmol/L
POST LUNCH BLOOD SUGAR 18-04-2024
493 mg/dl 140-0 mg/dl
PERIPHERAL SMEAR 18-04-2024
RBC : Microcytic hypochromic
WBC :increased counts on smear
PLATELET : Adequate
ABG 18-04-2024 03:42:PM
PH 7.41
PCO2 24.0
PO2 90.8
HCO3 15.2
St.HCO3 18.0
BEB -7.9
BEecf -8.4
TCO2 32.2
O2 Sat 96.6
O2 Count 11.8
ABG 18-04-2024 10:54:PM
PH 7.36
PCO2 31.7
PO2 39.7
HCO3 17.5
St.HCO3 18.6
BEB -6.8
BEecf -6.9
TCO2 38.1
O2 Sat 75.4
O2 Count 7.7
SERUM ELECTROLYTES (Na, K, C l) 18-04-2024 10:54:PM
SODIUM 128 mmol/L 145-136 mmol/L
POTASSIUM 3.8 mmol/L 5.1-3.5 mmol/L
CHLORIDE 104 mmol/L 98-107 mmol/L
SERUM ELECTROLYTES (Na, K, C l) 19-04-2024 11:54:AM
SODIUM 134 mmol/L 145-136 mmol/L
POTASSIUM 3.9 mmol/L 5.1-3.5 mmol/L
CHLORIDE 105 mmol/L 98-107 mmol/L
COMPLETE URINE EXAMINATION (CUE) 19-04-2024 11:54:AM
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN +
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 2-4
EPITHELIAL CELLS 2-3
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
ABG 19-04-2024 04:44:PM
PH 7.42
PCO2 28.7
PO2 73.8
HCO3 18.5
St.HCO3 20.5
BEB -4.7
BEecf -5.1
TCO2 39.1
O2 Sat 95.7
O2 Count 11.4
SERUM ELECTROLYTES (Na, K, C l) 19-04-2024 11:06:PM
SODIUM 137 mmol/L 145-136 mmol/L
POTASSIUM 4.0 mmol/L 5.1-3.5 mmol/L
CHLORIDE 105 mmol/L 98-107 mmol/L
HEMOGRAM 19/4/24
HB - 7.6
TLC-14,400
PCV - 22.8
RBC - 3.9
SMEAR - MICROCYTIC HYPOCHROMIC
HBA1C - 7.6 %
RETICULOCYTE COUNT - 0.9 %
URINE FOR KETONE BODIES - NEGATIVE
USG REPORT ;
IMPRESSION - NO SONOLOGICAL ABNORMALITY DETECTED
2D ECHO ;
IMPRESSION - NO RWMA
MODERATE TR + WITH MILD PAH ( ECCENTRIC TYPE
MILD AR + , TRIVIAL MR +
SCLEROTIC AV NO AS MS , IAS INTACT
MAC +
EF 61 %
RV SP2 38 + 10 = 48 MM HG
GOOD LV SYTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION - NO PE
IVC SIZE - 1.0 CM COLLAPSING
21/4/24 -
HB - 8 GM/DL
TLC-8000 CELLS/CUMM
PLATELETS -3.2
REFERRAL
OPHTHALMOLOGY REFERRAL I/V/O DIABETIC RETINOPATHY ON 20/4/24
IMPRESSION - BE MODERATE NPDR CHANGES NOTED
ADVICE - REVIEW FUNDOSCOPY EVERY 3 MONTHS
PSYCHIATRY REFERRAL I/V/O ?MANIA(PSYCHOTIC EPISODE) ON 21/4/24
ADVICE:
T.CLONAZEPAM MD 0.5MG PO/SOS
IF ANXIOUS/RESTLESS
RELAXATION AND DIVERSION TECHNIQUES EXPLAINED
DIETICIAN REFERAL I/V/O UNCONTROLLED SUGARS
ADVICE - DIABETIC DIET EXPLAINED
FROM 28-04-2024 TO 03-05-2024
COMPLETE URINE EXAMINATION (CUE) 28-04-2024 05:16:PM
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN +++
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 4-5
EPITHELIAL CELLS 2-4
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITS Absent
OTHERS Nil
RFT 28-04-2024 05:16:PM
UREA 21 mg/dl 42-12 mg/dl
CREATININE 0.9 mg/dl 1.1-0.6 mg/dl
URIC ACID 2.8 mmol/L 6-2.6 mmol/L
CALCIUM 10.0 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 2.0 mg/dl 4.5-2.5 mg/dl
SODIUM 137 mmol/L 145-136 mmol/L
POTASSIUM 3.6 mmol/L. 5.1-3.5 mmol/L.
CHLORIDE 103 mmol/L 98-107 mmol/L
POST LUNCH BLOOD SUGAR 28-04-2024
237 mg/dl 140-0 mg/dl
WIDAL TEST 28-04-2024 05:19:PM
S.typhi "O" Antibodies 1:20
S.typhi "H" Antibodies 1:40
S.PARATYPHI "AH" ANTIBODY No Agglutination seen
S.PARATYPHI "BH" ANTIBODY No Agglutination seen
HEMOGRAM
28/4/24 -
HB-7.7
TLC-16000
PLT-4.07
RBC-4.05
29/4/24
HB-6.3
TLC-13200
PLT-2.77
RBC-3.39
30/4/24
HB-6.1
TLC-97200
PLT-2.99
RBC-3.25
DIAGNOSIS
ENTERIC FEVER
DIABETES MELLITUS SINCE 9 YEARS
HYPERTENSION SINCE 1 WEEK
WITH ANEMIA-MCHC SECONDARY TO NUTRITIONAL CAUSE
***ALSO URINARY TRACT INFECTION +
[ IT WAS REALISED DURING HER 4th VISIT (may,2024) THAT SHE ALSO HAD URINARY TRACT INFECTION (UTI+) and THIS DIAGNOSIS WAS MISSED DURING HER 3rd VISIT and WAS ALSO NOT MENTIONED IN THE 3rd VISIT DISCHARGE SUMMARY, DATED 24-04-2024.]
Treatment Given
INJ AUGMENTIN 1.2GM IV/BD
INJ PAN 40MG IV/OD
INJ HAI S/C TID
INJ NPH S/C BD ACC TO GRBS
T.METFORMIN 500MG PO/OD
TAB TELMA 20MG PO/OD
T.DOLO 650MG PO/SOS
INJ IRON SUCROSE 200MG IN 100ML NS IV/OD
Advice at Discharge [Discharge Date- 3/5/24 ]
T.METFORMIN 500MG PO/OD
TAB TELMA 20MG PO/OD
T.DOLO 650MG PO/SOS
DAILY ACTIVITY CHART
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