CBBLE UDHC SIMILAR CASE STUDY

​A 50 yr old male came to casuality with complaints of fever since 3days and vomitings since 3 days .

Patient was apparently asymptomatic 3 days back then he had  intermittent fever  which is insidious in onset not associated with cold and cough and relieved with medications and vomitings since 3 days after eating food and food as content  , non projectile, non bilious .

No h/o loose motions , burning micturition , dyspnea , headache , darkstools , bleeding from gums .

k/c/o DM since 6 years on medication metformin 500 mg 

K/c/o HTN since 3 years not on regular medication and patient does not know the name of medication 

Family history : not significant 

Personal history : Diet : mixed 

                                Appetite : normal 

  H/o alcohol intake daily 90 ml from 10 yrs .

O/E : pt is c/c/c

No pallor , cyanosis , clubbing , 

Icterus ( ), edema upto the ankles 

PR: 80 bpm

Bp: supine :110/70 mmhg 

       Prone: 110/70 mm hg 


Spo2 : 97 %

CVS : s1s2

Cns : NAD

RS: BAE

P/A: soft , Bs , NT 

       on percussion : hepatomegaly

Investigations:

Usg abdomen : Gall bladder oedema 

Usg of swelling over rt mandible :  

E/o 4.5x3cm solid cystic lesion  with solid component showing increased vascularity noted in superficial lobe of right parotid extending into deep lobe.

Enlarged 1b cervical lymph node measuring 9mm along SAD   


Dx-viral pyrexia with thrombocytopenia with AKI with pleomorphic adenoma with obstructive jaundice


Rx:1) IVF NS , RL @150ml /hr 

      2)Grbs charting 8 th hrly 

      3) Temp charting hrly 


Amc UPDATE 

27/3/22


50year /male


S-C/o Fever , c/o vomitings subsided 

O-

O/E:No pallor/Cyanosis/Clubbing. 

Icterus ( ), edema above the ankles 


Enlarged 1b cervical lymph node measuring 9mm along SAD  


Temp:98.4f 

PR:98bpm

RR:22cpm

BP:supine :130/90mm of hg

       Prone : 130/90mm of hg 

CVS:S1,S2 heard,no murmurs

RS:BAE ,NVBS heard

P/A:SOFT,NONTENDER,BS , Hepatomegaly ( )

A: Dx-viral pyrexia with thrombocytopenia with AKI with pleomorphic adenoma with obstructive jaundice


P-

Rx:1) IVF NS , RL @150ml /hr 

      2)Grbs charting 8 th hrly 

      3) Temp charting hrly 

      4) Strict I/o charting


Amc UPDATE 

28/3/22


50year /male


S-C/o Nausea , c/o fever  subsided 

O-

O/E:No pallor/Cyanosis/Clubbing. 

Icterus ( ), edema above the ankles 


Enlarged 1b cervical lymph node measuring 9mm along SAD  


Temp: 98.4 f

PR:89 bpm

RR:20 cpm

BP:supine :130/80 mm of hg

       Standing : 130/80 mm of hg 


I/O 2600/1500ml


CVS:S1,S2 heard,no murmurs

RS:BAE ,NVBS heard

P/A:SOFT,NONTENDER,BS , Hepatomegaly ( )

Hb:11.3

Plt count:20000

TLC:10600

Sr creatinine:4.9 mg/dl

Blood urea:101mg/dl

Total Bilirubin :6.30 mg/dl

Direct Bilirubin:4.42 mg/dl


Amc UPDATE 

29/3/22


50year /male


S-C/o Nausea , c/o loss of appetite 

O-

O/E:No pallor/Cyanosis/Clubbing. 

Icterus (+), edema above the ankles 


Enlarged 1b cervical lymph node measuring 9mm along SAD  


Temp: 98.4 f

PR:89 bpm

RR:20 cpm

BP:supine :140/100mm of hg

       Standing : 110/90mm of hg 


I/O 2600/1500ml->>2700ml/1600ml


CVS:S1,S2 heard,no murmurs

RS:BAE+,NVBS heard

P/A:SOFT,NONTENDER,BS+ , Hepatomegaly (+)

Hb:11..6->11.6->11.9

Plt count:20000->40000->1 lakh 

TLC:8550->10600->14200

Sr creatinine:5.6->4.9->3.8

Blood urea:121->101->83

Total Bilirubin :4.19->6.30->  5.72

Direct Bilirubin:4.42->4.42->4.68


A: Dx-viral pyrexia with thrombocytopenia with AKI with pleomorphic adenoma with obstructive jaundice


P-

Rx:1) IVF NS , RL @100ml /hr 

      2)Grbs charting 6th hrly 

      3) Temp charting2 hrly

      4) Strict I/o charting

5. Inj Zofer 4mg IV /sos 





A: Dx-viral pyrexia with thrombocytopenia with AKI with pleomorphic adenoma with obstructive jaundice


P-

Rx:1) IVF NS , RL @150ml /hr 

      2)Grbs charting 8 th hrly 

      3) Temp charting hrly 

      4) Strict I/o charting

5. Inj Zofer 4mg IV /sos 






      


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