65 year old with fever , myalgia and radiculopathy

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65 year old male ,farmer hailing from nagarjun sagar came to casualty with chief complaints of

● fever since 5 days

● backache since 5 days 

History of present illness:

>Patient was apparently asymptomatic 5 days back , then developed high grade continous fever with chills, rigors  subsiding on medication(injections taken)

>There was 1 episode of vomiting - non projectile , food particles as contents , no blood 

>he had sharp pain in the back radiating to his legs , not relieved on medication  ,associated with myalgia

> patient initially had difficulty to pass stools , but gradually was relieved of the problem

>No complaints SOB,cough,burning micturition

Past history :

>5 years back patient had complaints of increased micturition (polyuria)

and was diagnosed as diabetic for which he was on insulin .Inj.MIXTARD 10U(morning) and 8U(night).

>4 years ago patient came to our hospital with c/o SOB and was told to have lung infection ,?mass . He was admitted for 5 days,was advised to stop smoking and drinking 

>Since 4 years patient had skin lesions with scaling over legs and hands which progressed gradually, for which he used steroids and tapered.As the lesions kept progressing patient underwent skin biopsy 1month ago at another hospital which showed munromicroabscess suggestive of psoriasis. He has been using medication for psoriasis since 1 month.

>H/O unstable angina 1 and half year back-PCA  was done.

>Not a K/C/O HTN,TB,asthma,epilepsy, thyroid disorders.

Personal history:

▪︎Diet-mixed
▪︎Appetite-normal
▪︎sleep-adequate
▪︎Bowel and bladder movements-regular

▪︎Smoker and alcoholic since 25 years but its been over 4 years he stopped both smoking and drinking 

Family history:

Not significant

General examination:

Patient is conscious, coherent, cooperative and is moderately built

No pallor,icterus,cyanosis,clubbing,lymphadenopathy,edema.

Vitals on admission: day 1
Temperature-99 F
PR-64 bpm
RR-18 cpm
BP-80/60 mmHg

Systemic examination:

CVS-S1,S2 heard,No murmurs
RS-BAE present
CNS-No FND
P/A-soft,non tender

Clinical images:

Psoriatic plaques on B/L upper and lower limbs:

Investigations:

Provisional dignosis:

Left lower lobe pneumonia ( bacterial > viral)

With H/O PCA 1 and half year back

With K/C/O DM-type 2

Psoriasis vulgaris 

Treatment:

IVF NS @150 ml/hr-bolus given

             @75 ml/hr- maintenance 

TAB.DOLO 650MG TID

INJ.NEOMOL 1G IV SOS

Temperature charting 4th hrly

INJ.AVIL 2CC SOS(IF CHILLS +)

GRBS monitoring 6th hrly

INJ.HUMAN ACTRAPID ACCORDING TO GRBS

TAB.ECOSPIRIN 75/20 MG PO OD

INJ.PIPTAZ 4G IV QID

Updates- 

Day 2:

S-  c/o headache and backache

No fever spikes

O-

Pt isC/C/C

Temp- 97.7 F

BP- 120/80 mmHg

PR- 100 bpm

CVS- S1S2 +

RS- BAE+, crepts + in Lt. IAA

P/A- soft, non tender

DM-II +

P- 

IVF NS,RL,DNS @75ml/hr

INJ. PIPTAZ 3.375 IV QID

TAB. DOLO 650 mg PO TID

INJ. NEOMOL 1 gm IV SOS

INJ. AVIL 2 cc IV SOS

Inj.PAN 40mg IV OD

INJ. HUMAN ACTRAPID S.C. According to GRBS

TAB. ECOSPIRIN-AV (75/20) mg PO OD

Temp charting 4th hourly

Grbs 6th hrly

Day 3:

S-  

One episode of vomiting today morning

Low backache +, Headache+

No fever spikes

O-

Pt isC/C/C

Temp- 97.7 F

BP- 120/80 mmHg

PR- 100 bpm

CVS- S1S2 +

RS- BAE+, crepts + in Lt. IAA

P/A- soft, non tender

Low back pain (2° to ? Radiculopathy)

Leg raising test + at 45° in Left Leg, 60° in Right Leg

P- 

IVF NS,RL @100ml/hr

INJ. PIPTAZ 3.375 IV QID

TAB. DOLO 650 mg PO TID

INJ. NEOMOL 1 gm IV SOS

INJ. AVIL 2 cc IV SOS

Inj.PAN 40mg IV OD

Inj.ZOFER 4mg IV BD

INJ. HUMAN ACTRAPID S.C. According to GRBS

TAB. ECOSPIRIN-AV (75/20) mg PO OD

TAB. VITRACET 1/2 PO QID

Temp charting 4th hourly

Grbs 6th hrly

Day 4 :

S-  

One episode of vomiting today morning

Low backache +, Headache+

No fever spikes

O-

Pt isC/C/C

Temp- 97.7 F

BP- 120/80 mmHg

PR- 100 bpm

CVS- S1S2 +

RS- BAE+, crepts + in Lt. IAA

P/A- soft, non tender

Low back pain (2° to ? Radiculopathy)

Leg raising test + at 45° in Left Leg, 60° in Right Leg

P- 

IVF NS,RL @100ml/hr

INJ. PIPTAZ 3.375 IV QID

TAB. DOLO 650 mg PO TID

INJ. NEOMOL 1 gm IV SOS

INJ. AVIL 2 cc IV SOS

Inj.PAN 40mg IV OD

Inj.ZOFER 4mg IV BD

INJ. HUMAN ACTRAPID S.C. According to GRBS

TAB. ECOSPIRIN-AV (75/20) mg PO OD

TAB. VITRACET 1/2 PO QID

Temp charting 4th hourly

Grbs 6th hrly

 Day 5:

S- c/o low backache +

Nausea +, pain abdomen on and off

Chills+ on and off every 4-6hrs

No fever spikes

O-

Pt isC/C/C

Temp- 97.7 F

BP- 120/80 mmHg

PR- 88 bpm

Grbs-130 mg/dl

CVS- S1S2 +

RS- BAE+

P/A- soft, non tender

P- 

IVF NS,RL,DNS @75ml/hr

INJ. PIPTAZ 3.375 IV QID

TAB. DOLO 650 mg PO TID

INJ. NEOMOL 1 gm IV SOS if temp >101°F

INJ. AVIL 2 cc IV SOS

Inj.PAN 40mg IV BD

Inj.ZOFER 4mg IV TID

Tab.METFORMIN 250mg PO OD

TAB. ECOSPIRIN-AV (75/20) mg PO OD

Inj.METACHLOPRAMIDE 1amp IV STAT

Temp charting 4th hourly

Grbs 6th hrly

Day 6:

S-  c/o low backache (reduced)

Nausea +

Chills+(reduced)

No fever spikes

O-

Pt isC/C/C

Temp- 98.7 F

BP- 150/90 mmHg

PR- 96 bpm

Grbs-115 mg/dl

CVS- S1S2 +

RS- BAE+

P/A- soft, non tender

P- 

IVF NS,RL,DNS @100ml/hr

TAB. DOLO 650 mg PO TID

INJ. NEOMOL 1 gm IV SOS if temp >101°F

INJ. AVIL 2 cc IV SOS

Inj.PAN 40mg IV BD

Inj.ZOFER 4mg IV TID

Tab.METFORMIN 250mg PO OD

TAB. ECOSPIRIN-AV (75/20) mg PO OD

Inj.METACHLOPRAMIDE 1amp IV STAT

Temp charting 4th hourly

Grbs 6th hrly

Patient discharged was discharged today(20th December )