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30 yr old male patient came with c/o
-fever since 8 days, vomitings since 2 days, decreased urine output and body pains since one day.
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic since 8 days later he developed fever which was high grade, intermittent.
H/o vomitings non projectile ,4-5 episodes on each day.
H/o body pains and decreased urine output since one day.
PAST HISTORY
He was deaf and dumb since childhood.
He had history of dialysis 10 yrs back(4 times)
He had tuberculosis one yr back and was on ATT for 6 months.
PERSONAL HISTORY:
Diet- Mixed
Appetite - reduced
Bowel and bladder movements - decreased urine output
No Addictions.
GENERAL EXAMINATION:
Patient was conscious coherent and cooperative.
No signs of pallor icterus cyanosis clubbing lymphadenopathy edema
Vitals:
Temp- Afebrile
RR- 40cpm
BP-60/40 mmHg
PR-112 bpm
SYSTEMIC EXAMINATION:
Abdomen:
Scaphoid shape
Abdominal tenderness present
Cardiovascular system:
S1 and S2 heard no murmurs heard
Central nervous system:
No focal neurological deficit, cranial nerve
intact
Cranial nerves- intact
Motor
Tone- normal
Power- normal
Cerebellar functions-normal
Respiratory system:
Bilateral air entry-present ,Normal vesicular breath sounds-heard
Diagnosis
Septic Shock with MODS
K/c/o Pulmonary Kochs 1 Year Back
H/o Dialysis 10 Years Back
Treatment
Inj Meropenem 500mg IV Bd
IV fluids NS 50ml/hr
RT feeds 100ml water 2nd hrly
100ml milk 4th hrly
Tab Doxycycline100mg RT BD
Inj Vasopressin 2.4ml/hr infusion
Inj Dobutamine 3.6ml/hr infusion
Inj Norad 2 ampules 46ml Ns
Tab Dolo 650mg RT BD
Inj Neomol IV sos
Inj Pantop40mg iv OD
Neb with Salbutamol 2 respules 4th hrly
Inj vit k 10mg in 100ml NS IV over 30 min
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