Saturday 4 December 2021

ACUTE GASTROENTERITIS

 This is online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputsThis e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome

Sasira Kasinadhuni 

ROLL NO 166

A 80 yr old Male presented with chief complaints of --

Vomitings 3 episodes 
loose stools 3 episodes
Fever since 1 day

HOPI -  
Patient was apparently asymptomatic 2 years back , then he had decreased urine output following which he was taken to near by hospital and was diagnosed with ? renal failure for which he was prescribed some medication and treated accordingly.
Patient c/o 3 episodes of vomitings which were non bilious, non projectile and had food particals as contents,
3 episodes of loose stools, watery in consistency not associated with blood.
H/o fever since yesterday morning, high grade (101 degree F) , they went to local hospital where his GRBS was 500mg/dl , then referred here to KIMS

Past history-

? K/c/o ckd with decreased urine output - has been using a tablet for urine output

N/k/c/o HTN , DM

PERSONAL HISTORY -
married,farmer by occupation with normal appetite and mixed diet , regular bowels, decreased urine output , alcoholic without other addictions

FAMILY HISTORY
Not significant

VITALS @ ADMISSION
Temperature: 100 degrees F
Pulse Rate: 94/min
RR:17cpm
BP: 80/60mmHg
SpO2: 91% at Room air
GRBS: 193 mg/dl

On examination:
NO Pallor, icterus, clubbing, cyanosis , lymphadenopathy and Edema
CVS: S1S2 +
RS : BAE + NVBS
P/A: Soft , Non tender
CNS: Intact , NAD

PROVISIONAL DIAGNOSIS:

ACUTE GASTROENTERITIS 2° to VIRAL
PRE-RENAL ARI (Resolved)

INVESTIGATIONS -

COMPLETE BLOOD PICTURE (CBP)
HAEMOGLOBIN: 13.0gm/dl
TOTAL COUNT: 11,100 cells/cumm
NEUTROPHILS: 86%
LYMPHOCYTES: 11%
EOSINOPHILS : 01%
MONOCYTES: 02%
BASOPHILS:00%
PLATELET COUNT: 1.61lakhs/cu.mm
SMEAR-
Normocytic normochromic with
neutrophilic leukocytosis

LIVER FUNCTION TEST (LFT)
Total Bilurubin : 0.81 mg/dl
Direct Bilurubin: 0.20 mg/dl
SGOT(AST): 27 IU/L
SGPT(ALT) : 25 IU/L
ALKALINE PHOSPHATE: 137 IU/L
TOTAL PROTEINS : 6.6gm/dl
ALBUMIN: 4.2gm/dl
A/G RATIO: 1.82

RFT 
UREA: 104mg/dl
CREATININE:2.9mg/dl
URIC ACID:6.4mg/dl
CALCIUM:10.1mg/dl
PHOSPHOROUS:4.0mg/dl
SODIUM:135mEq/L
POTASSIUM:3.6mEq/L
CHLORIDE:90mEq/L

USG



CUE
             
FBS- 197 mg/dl
HbsAg Rapid - NEGATIVE 
HIV RAPID- NON REACTIVE 
ANTI HCV ANTIBODIES- NON REACTIVE
TROPONIN I - NEGATIVE 

Treatment 
on 30/11/21

1)IVF:1 NS,1DNS, 1RL @100ML/HR
2)INJ.PAN 40 IV/OD
3)INJ.ZOFER 4 MG IV/SOS
4)INJ. OPTINEURON 1 AMP 100ml NS IV/ OD
5) TAB. DOLO 650 MG TID
6)INJ.METROGYL 500 MG IV/ TID
7)BP/ PR / TEMP MONITORING 4th HOURLY
8) GRBS 8th HOURLY

Update - 

●On 1/12/21
O/E pt conscious
BP - 80/60mmhg
PR - 90bpm
Cvs- S1,S2 +
RS - BAE+
P/A - Soft and non tender
CNS - No FND

1)IVF:1 NS,1DNS, 1RL @100ML/HR
2)INJ.PAN 40 IV/OD
3)INJ.ZOFER 4 MG IV/SOS
4)INJ. OPTINEURON 1 AMP 100ml NS IV/ OD
5) TAB. DOLO 650 MG TID
6)INJ.METROGYL 500 MG IV/ TID
7)BP/ PR / TEMP MONITORING 4th HOURLY
8) GRBS 8th HOURLY
9)INJ CIPROFLOXACIN 500mg/IV/BD
10)Cap AD 100/po/BD
11)ORS satchets - 1 packet in 1 liter of water
Drink 200 ml after each loose stool

2D echo report - 


● On 2/12/21
O/E pt conscious
BP - 100/60mmhg
PR - 90bpm
Cvs- S1,S2 +
RS - BAE+
P/A - Soft and non tender
CNS - No FND

1)IVF:1 NS,1DNS, 1RL @100ML/HR
2)INJ.PAN 40 IV/OD
3)INJ.ZOFER 4 MG IV/SOS
4)INJ. OPTINEURON 1 AMP 100ml NS IV/ OD
5) TAB. DOLO 650 MG TID
6)INJ.METROGYL 500 MG IV/ TID
7)BP/ PR / TEMP MONITORING 4th HOURLY
8) GRBS 8th HOURLY
9)INJ CIPROFLOXACIN 500mg/IV/BD
10)Cap AD 100/po/BD
11)ORS satchets - 1 packet in 1 liter of water
  ▪︎Advised high potassium diet
 ▪︎Stool sample microscopy ,fundoscopy and FLC advised

● On 3/12/21
O/E pt conscious
BP - 110/60mmhg
PR - 76bpm
Cvs- S1,S2 +
RS - BAE+
P/A - Soft and non tender
CNS - No FND

1)IVF:1 NS,1DNS, 1RL @100ML/HR
2)INJ.PAN 40 IV/OD
3)INJ.ZOFER 4 MG IV/SOS
4)INJ. OPTINEURON 1 AMP 100ml NS IV/ OD
5) TAB. DOLO 650 MG TID
6)INJ.METROGYL 500 MG IV/ TID
7)BP/ PR / TEMP MONITORING 4th HOURLY
8) GRBS 8th HOURLY
9)INJ CIPROFLOXACIN 500mg/IV/BD
10)Cap AD 100/po/BD
11)ORS satchets - 1 packet in 1 liter of water
 
Advised Referrals- 

Opthalmology-

Gastroenterology-


Fundoscopy- No DR 
FLC- absent/normal

●On 4/12/21
O/E pt conscious
BP - 100/70mmhg
PR - 82bpm
Cvs- S1,S2 +
RS - BAE+
P/A - Soft and non tender
CNS - No FND

1)IVF:1 NS,1DNS, 1RL @100ML/HR
2)INJ.PAN 40 IV/OD
3)INJ.ZOFER 4 MG IV/SOS
4)INJ. OPTINEURON 1 AMP 100ml NS IV/ OD
5) TAB. DOLO 650 MG TID
6)INJ.METROGYL 500 MG IV/ TID
7)BP/ PR / TEMP MONITORING 4th HOURLY
8) GRBS 8th HOURLY
9)INJ CIPROFLOXACIN 500mg/IV/BD
10)Cap AD 100/po/BD
11)ORS satchets - 1 packet in 1 liter of water

Stool sample-  






fecal leukocyte count - no pus cells seen
No ova/cyst

▪︎Patient advised to be shifted to ward

5/12/2021

O/E pt conscious
PT IS C/C/C
PR: 86bpm
BP: 110/70mmHg
RR- 18cpm
RS: BAE+
CVS: S1S2 +
P/A: soft,non tender
CNS: NO FND

1)IVF DNS&RL @100ml/hr
2)Inj. PAN 40mg /IV/OD
3)Inj. ZOFER 4mg/IV/SOS
4)Inj. METROGYL 500mg/IV/TID
5)Inj. OPTINEURON 1amp in 100ml NS/IV/OD
6)Tab. DOLO 650mg/PO/TID
7)Inj. HAI SIC acc. to sliding scale 
8)Inj. CIPROFLOXACIN 500mg BD
9)Cap. REDOTIL 100mg BD
10)ORS sachets in water 
100ml/PO/ after every episode of loose stools
11)Inj. HAI s/c
12)BP/PR/Temp charting
13)Tab. SPOROLAC-DS 1 tab po/BD

 6/12/2021

O/E 
PT IS C/C/C
PR: 84bpm
BP: 110/70mmHg
RR- 18cpm
RS: BAE+
CVS: S1S2 +
P/A: soft,non tender
CNS: NO FND

1)IVF DNS&RL @100ml/hr
2)Inj. PAN 40mg /IV/OD
3)Inj. ZOFER 4mg/IV/SOS
4)Tab. DOLO 650mg/PO/TID
5)Inj. HAI S/C acc. to sliding scale 
6)ORS sachets in water 
100ml/PO/ after every episode of loose stools
7)BP/PR/Temp charting
8)GRBS Charting 4th hrly

>Patient has been discharged on 6th december


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