Case 37 54 male with fever ,facial puffiness and yellowish discoloration of eyes

Doa 3/1/24

Dod 15/1/24

Diagnosis

COMPLICATED MALARIA WITH HEMOLYSIS

HEART FAILURE WITH PRESERVED EJECTION FRACTION SECONDARY TO ANAEMIA

HYPERTENSION

TYPE II DIABETES MELLITTUS

Case History and Clinical Findings

C/O FEVER SINCE 1 WEEK

FACIAL PUFFINESS SINCE 1 WEEK

YELLOWISH DISCOLORATION OF EYES SINCE 1 DAY

HOPI

PT WAS APPARENTLY ASYMPTOMATIC 1 WEEK BACK THEN DEVELOPED FEVR , INSIDIOUS

ONSET,HIGH GRADE,ON AND OFF AT NIGHT .

FACIAL PUFFINESS MORE IN THE MORNING GRADUALLY IMPROVING BY EVENING.

C/O YELLOWISH DISCOLORATION OF EYE

H/O INCREASED URINE OUTPUT SINCE 6 DAYS

H/O COUGH SINCE 6 DAYS

NO H/O CHEST PAIN, ABDOMINAL PAIN.

NO H/O ABDOMINAL DISTENSION, PEDAL EDEMA

NO H/O BURNNG MICTURITION

NO H/O LOOSE STOOLS, VOMITINGS.

PAST HISTORY

K/C/O TYPE 2 DM SINCE 1 YEAR ON TAB METFORMIN 500MG , TAB GLIMIPERIDE 2 MG OD

HTN SINCE 3 YEARS ON TELMA 40

NOT A K/C/O EPILEPSY,THYROID DISORDERS,ASTHMA,TB,CAD,CVA

PERSONAL HISTORY:

DIET:MIXED

SLEEP:ADEQUATE

BOWEL AND BLADDER:REGULAR

ADDICTIONS: OCCASIONAL

APPETITE:NORMAL

GENERAL EXAMINATION:

PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE,WELL ORIENTED TO TIME,PLACE AND

PERSON.

PALLOR PRESENT

ICTERUS PRESENT

NO CYANOSIS,CLUBING,LYMPHADENOPATHY,EDEMA.

VITALS:

TEMPERATURE:98.6

BP:140/80 MM HG

PR:76 BPM

RR:18 CPM

SPO2:98 ON RA

GRBS: 215

SYSTEMIC EXAMINATION:

CVS:S1,S2 HEARD ,MURMURS PRESENT.

RS:BAE +,NVBS

PER ABDOMEN:SOFT,NON TENDER,NO ORGANOMEGALY

OPHTHAL REFFERAL WAS DONE IN VIEW OF DIABETIC RETINOPATHY CHANGES , FUNDUS

WAS FOUND TO BE NORMAL .

ADVISED SPECTACLES I/V/O REFRACTIVE ERROR

2 UNITS OF PRBC TRANSFUSION WAS DONE ON 9/1/24 AND 11/1/24

COURSE IN THE HOSPITAL

53 YR OLD MALE DIABETIC AND HYPERTENSIVE CAME WITH COMPLAINTS OF FEVER SINCE

6 DAYS,FACIAL PUFFINESS SINCE 6 DAYS,YELLOWISH DISCOLORATION OF EYES SINCE 1

DAY ,VITALS WERE STABLE STARTED ON SYMPTOMATIC TREATMENT ON DAY 1 .PATIENT

DEVELOPED FEVER SPIKES HEMATURIA FROM DAY 3 PERIPHERAL SMEAR SHOWED

DIMORPHIC ANEMIA ,USG ABDOMEN SHOWED SPLENOMEGALY ,LIVER FUNCTION TESTS

WERE DERRANGED,SMEAR FOR MALARAIL PARASITE NEGATIVE ,LDH RAISED ,GIVEN INJ

VITCOFOL 1500MCG I/M OD STATRED EMPERICALLY ON INJ FALCIGO 0-12-24-48HRS,TAB

ACT KIT X 3 DAYS ,TAB PRIMAQUINE 7.5MG X 7 TABLETS ON DAY 2 OF ACT KIT,INJ

MONOCEF 1GM IOV BD,INJ DOXYCYCLINE 100MG IV BD ,2 PINT PRBC TRANSFUSION DONE

.HEMATURIA DECREASED,FEVER SPIKES ARE ABSENT,HEMOGLOBIN LEVELS ,TOTAL

COUNTS IMPROVED.

Investigation

DAY 1

03-01-2024

HEMOGRAM

HB 4.4

TLC 4,000

PLT 2.2

MCV 17.9

PCV 16.7

LIVER FUNCTION TEST (LFT)

Total Bilurubin

2.50 mg/dl

Direct Bilurubin

0.70 mg/dl

SGOT(AST)

126 IU/L

SGPT (ALT)

30 IU/L

HBsAg-RAPID

Negative

Anti HCV Antibodies - RAPID

Non Reactive

WIDAL NEGATIVE

BLOOD UREA

20 mg/dl

SERUM CREATININE

0.8 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM

SODIUM

139 mEq/L

POTASSIUM

4.2 mEq/L

CHLORIDE

103 mEq/L

CALCIUM IONIZED

1.10 mmol/L

STOOL FOR OCCULT BLOOD

Negative (-ve)

T3, T4, TSH 04-01-2024

T3

1.05 ng/ml

T4

12.00 micro g/dl

TSH

2.58 micro Iu/ml

POST LUNCH BLOOD SUGAR04-01-2024 11:05:PM

90 mg/dl

140-0 mg/dl

LIVER FUNCTION TEST (LFT) 08-01-2024

Total Bilurubin

6.35 mg/dl

Direct Bilurubin

1.74 mg/dl

SGOT(AST)

185 IU/L

SGPT(ALT)

26 IU/L

ALKALINE PHOSPHATE

123 IU/L

TOTAL PROTEINS

6.9 gm/dl

ALBUMIN

4.4 gm/dl

A/G RATIO

1.76

FBS 133 mg/dl

PLBS 159 mg/dl

Hba1c 6.6%

CUE ON 08/1/24

ALB - Nil

SUGARS NIL

PUS CELS loaded

EPITHELIAL CELLS 4-8

RED BLOOD CELLS loaded

CASTS RBC casts present

HEMOGRAM ON 10/1/24

HB 5.4

TLC 1,600

PLT 1.45

MCV 80.4

PCV 16

HEMOGRAM ON 11/1/24

HB 4.1

TLC 2,800

PLT 1.53

MCV 85.3

PCV 9.3

HEMOGRAM ON 12/1/24

HB 5.4

TLC 1,800

PLT 1.4

MCV 77.3

PCV 17

HEMOGRAM ON 13/1/24

HB 5.6

TLC 1,500

PLT 1.2

MCV 84.3

PCV 12.

HEMOGRAM ON 14/1/2024

HB 5.5

TLC 1,700

PLT 1.9

MCV 75

PCV 17.4

CUE ON 14/1/24

ALB - +

SUGARS NIL

PUS CELS 2-3

EPITHELIAL CELLS 2-3

HEMOGRAM ON 15/01/2024

HB - 7.0

TOTAL COUNTS -2600

PLATELET -2.0 LAKHS

RBC -2.9 MILLION/CUMM

PCV -22.8

MCV - 77.6

LFT ON 15/01/2024

TB -0.82

DB -0.20

SGOT -69

SGPT -84

ALP -211

TOTAL PROTEINS 6.4

ALBUMIN -2.4

2D ECHO

LEFT VENTRICLE - DILATED,NO RWMA MILD LVH

EF -68%

MINIMAL PERICARDIAL EFFUSION

IVC SIZE 1.11 CMC COLLAPSING

MODERATE AR GOOD LV SYSTOLIC FUNCTION

NO DIASTOLIC DYSFUNCTION

NO PAH

USG ABDOMEN AND PELVIS

SPLENOMEGALY

GRADE 1 PROSTATOMEGALY

Treatment Given(Enter only Generic Name)

TAB CEPODEM XP 325MG PO BD

TAB DOLO 65OMG PO TID TAB OROFER XT OD BBF

TAB GLIMI M2 OD

TAB TELMA 40MG OD

INJ IRON SUCROSE 1AMP 1N 100ML NS OVER 40MIN IV OD

INJ VITCOFOL 1ML IM OD

TAB TUSQ PO TID

INJ FALCIGO IV 0- 12-24-48 HRS

TAB ACT KIT X 3 DAYS

TAB PRIMAQUINE 7.5MG X 7 TABLETS ON DAY 2 OF ACT KIT

INJ MONOCEF 1GM IOV BD

INJ DOXYCYCLINE 100MG IV BD

Advice at Discharge

TAB LIVOGEN 150 MG OD FOR 30 DAYS

INJ VITCOFOL 1000MCG DAILY FOR 1 WEEK F/B ALTERNATE DAY FOR 1 WEEK F/B WEEKLY

ONCE FOR 1 MONTH

TAB TELMA 40M MG OD CONTINUE

TAB GLIMI M2 OD CONTINUE

TAB CEPODEM XP 325 MG PO BD FOR 2 DAYS

TAB PAN 40 MG PO OD FOR 5 DAYS

TAB PCM 650 MG PO SOS

Followup on september 2024

Patient is doing well

Fbs 100 PLBS 176 Hba1c 6.3%

Further follow up lost