66yr old male came with fever( 3 days) DM2 -20yrs Left lower limb filariasis
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CASE SCENARIO:
66yr old male patient resident of kallepally farmer by occupation came with complaints of fever high grade since 2 days and complaints of generalised weakness
History of presenting illness:
Patient was apparently asymptomatic 3 days ago the he developed fever
High grade intermittent type which is associated with chills and relieved on medication then has generalised weakness since 2 days where patient was unable to do routine activity since the morning
History of giddiness present and also patient had fall ,loss of consciousness for 5 min , shortness of breathe
History of past illness:
K/c/o diabetes mellitus type 2 since 20 days
H/o left lowerlimb swelling due to filariasis since 20 years
N/k/o HTN ,epilepsy ,thyroid ,CAD
TREATMENT HISTORY:
On medication for diabetes
PERSONAL HISTORY:
Married
Occupation: farmer
Diet: Mixed , Non vegetarian
Appetite: Normal
Bowels: constipation
Micturation: normal
Known Allergies: No
addictions. Regular alcoholic since 5 years
FAMILY HISTORY:not significant
General Examination.
No Pallor,icterus , cyanosis, clubbing , lymphadenopathy, pedal edema
Patient is conscious and coherent cooperative
Vitals:
Temperature - 99F
BP:-130/80mmhg ,
PR:- 102bpm,
RR- 26cpm,
Spo2:-100%on RA
GRBS:96mg/dl
Systemic examination:
CARDIOVASCULAR SYSTEM
Thrills: No
Cardiac sounds: S1 , S2
Cardiac murmurs: No
RESPIRATORY SYSTEM
Dyspnoea:No
Wheeze: No
Position of trachea: Central
Breath sounds: Vesicular
Adventitious sounds : No
ABDOMEN
Shape - Scaphoid
No tenderness, palpable mass, No Fluid
No bruits
Liver not palpable
Spleen not palpable.
Bowel sounds present.
CNS Examination:
Conscious coherent cooperative.
Speech normal.
No signs of meningeal irritation
Cranial nerves
Reflexes :
biceps triceps knee
Right +3 +2 +3
Left +3 +2 +3
Cerebellar :
Fingernose incoordination -no
Provisional diagnosis:
Viral pyrexia k/c/o diabetes mellitus type 2
Investigations:
2.IV FLUIDS NS 100ml/hr
3.INJ.NEOMOL 1gm/IV/SDS
4.INJ.HAI according to the Grbs >=200mg/dl
5.TAB.DOLO 650mg/PO TID
1-----1-----1
6.GRBS profile monitoring
7.Monitor vitals 2hrly
8.INJ.DOXYCYCLINE 200mgIV/STAT---->Hb-->
Inj.DOXYCCYCLINE 100mg/IV/BD
1-----×----1
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