63/M WITH FEVER SINCE YESTERDAY AFTERNOON,DECREASED URINE OUTPUT SINCE 1DAY AND SHORTNESS OF BREATH SINCE 1DAY



Unit 3-
Interns-
Jeeharika
Archana
Harsha
Kalyan
Sreeja


Dr.Raveen PG1
Dr.Aashitha PG2
Dr.Vamshi PG3
Dr.Aravind PG3

Dr.Hareen SR
Dr.Praveen Naik Ass.Prof


63 year old male with complaints of fever since yesterday afternoon,decreased urine output since 1day,shortness of breath since 1day.


Patient was apparently asymptomatic since yesterday afternoon and developed fever which was insidious in onset, intermittent type,no diurnal variation .Decreased urine output since 1day.Shortness of breath since 1day, grade 2 progressed to grade 4 (seen on presentation). History of weakness of both upperlimbs 6 years back. Unable to get up from bed 6 years back and had a similar episode 2days back and was told to have low potassium (not on any regular medication).
No h/o vomitings,loose stools,burning micturation
Not a k/c/o HTN,DM,EPILEPSY,CAD,ASTHMA
TB

Vitals:

Temp:99.6F
BP:100/60MMHG
HR:91BPM
RR:20CPM
GRBS:140MG/DL
SPO2:94% WITH 1LITRE OF O2

Systemic examination: 
CVS: s1,s2 heard, no murmurs 
RS: BAE present, no added sounds 
P/A: soft, non - tender 
CNS: 
Increased tone in both upper and lower limbs.
Reflexes 
                             Right.                     Left
Biceps.               0.                               0
Triceps.              0.                                0
Supinator.          0.                                0
Knee.                   ++.                           ++
Ankle.                    +.                             +
Plantar.                Withdrawal.        Withdrawal
Patient got intubated yesterday 
His GCS was E2V2M5

Investigations
DAY 1

Diagnosis:
Altered sensorium secondary to ?acute CVA
Sub arachnoid haemorrhage in left frontal lobe(3.4 mm)
AKI with B/L Hydroureteronephrosis
Hypokalemia secondary to ?laxative usage
?Acute cholecystitis with cholilithiasis
(Hypercapnea resolved on MV) 

DAY 1:
1.Propped up posture,frequent change of position every 2nd hourly.
2.Air water bed
3.IVF 1unit RL,2unit NS @75ml/hr
4.Ryles tube feeding
Milk + protein powder-100ml,free water-50 ml 4th hourly
5.Inj ceftriazone 1gm/IV/BD
6.Inj PAN 40MG IV OD
7..Inj PCM 650MG/RT/TID
8.Inj KCL 2ampoules in 1unit NS @100ml /hr
9.Inj nor adrenaline @4ml /hr
10.Inj ZOFER 4mg/IV/BD
11.BP/PR/SPO2/TEMP charting 2nd hourly
12.Strict I/o charting
13.GRBS 6th hourly
14.Syrup KCL 10ml in 1glass water TID/RT

DAY 2:
TREATMENT:         
  1.Propped up posture,frequent change of position every 2nd hourly.
2.Air water bed
3.IVF 1unit RL,2unit NS @75ml/hr
4.Ryles tube feeding
Milk + protein powder-100ml,free water-50 ml 4th hourly
5.Inj ceftriazone 1gm/IV/BD
6.Inj PAN 40MG IV OD
7..Inj PCM 650MG/RT/TID
8.Inj KCL 2ampoules in 500ml NS IV / over 4-5 hours
9.Inj nor adrenaline @4ml /hr
10.Inj ZOFER 4mg/IV/BD
11.BP/PR/SPO2/TEMP charting 2nd hourly
12.GRBS 6th hourly
13.Strict I/O CHARTING
14.Syrup kcl 15 ml in 1glass of water /RT/ TID
DAY 3:


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