45 yr old male with urosepsis
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A 45 year old male resident of cherlapally farmer by occupation came with complaints of fever since 2 days and slurring of speech since 1 day (28/07/2022)
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 2 yrs back.
Then his appetite increased for which he came to our hospital and diagnosed with Diabetes.
He used oral hypoglycemic agents for the first six months and from past one and half year he is on insulin
History of increased urine output since 2 years
History of weight loss(25 kgs) since 2 yrs
Then since 2 days he developed fever which was high grade continuous and was associated with chills and rigor.
And he developed slurring of speech since 1 day and next day morning they came to our hospital
DAILY ROUTINE
Wake up in the morning by 4am then he will have milk by 5am and then he eat food (rice)by8am and then he goes for cattle rearing come back by 3pm then he takes some food rest and then he takes food at 6pm and goes to sleep by 7pm
PAST HISTORY
No similar complaints in the past
PERSONAL HISTORY
Diet:mixed
Appetite: increased
Sleep: adequate
Bowel and bladder movements increased
Addictions: Alcohol since 25 yrs (180ml/day)yerramandu and Kallu
No History of smoking
Family history:No significant family history
Drug history:No history of allergy to any drugs
GENERAL EXAMINATION
Patient was conscious coherent and cooperative Well oriented with time ,place and person
Poorly built and nourished
pallor present
No Icterus
No cyanosis
No clubbing
No generalized lymphadenopathy
Bilateral pedal edema (pitting) present
Vitals
Temp Afebrile
PR 65 bpm
BP 100/70 mm Hg
RR 16 cpm
GRBS 249 mg/ dl
SYSTAMIC EXAMINATION
Central nervous system
Higher mental functions:
Patient was drowsy
Speech slurred speech
Memory Recent and Remote
Motor system
Bulk decreased
Tone normal in all 4 limbs
Power 4/5 in all 4 limbs
SUPERFICIAL REFLEXES:. Right. Left
Corneal reflex present
Conjunctival reflex. Present
DEEP TENDO8N REFLEXES:
Right. Left
BICEPS JERK. Absent Present
TRICEPS. Absent. Absent
KNEE JERK absent. Absent
ANKLE JERK present. Present
SUPINATOR. Absent. Absent
Sensory system
Crude touch ,pain, temperature, fine touch ,two point discrimination Normal
Gait:
https://youtube.com/shorts/OvQdamoY4ps?feature=share
Signs of meningeal irritation neck stiffness present
Respiratory system:
Inspection:
Shape of chest: bilaterally symmetrical chest
No scars and sinuses
Trachea central
Palpation:
Inspectory findings are confirmed
Palpable sounds are felt
Percussion: tympanic
Auscultation
Normal vesicular breath sounds heard all over the chest
Per abdomen:
Inspection:
No abdominal distension
No scars, sinuses, masses visible
Umbilicus slit like
Palpation:
Inspectory findings are confirmed
No Tenderness
Percussion:
Shifting dullness present
Dull note Heard near the flanks
Auscultation: Normal bowel sounds heard
No bruit heard
Cardiovascular system:
Inspection :
No scars, sinuses
No visible pulsations
Palpation:
Inspectory findings are confirmed
Apex beat normal
On Auscultation :
S1 S2 heard
No murmurs or additional heart sounds
INVESTIGATIONS
CBP
PVD-urosepsis
TREATMENT
Meropenem -500mg IV BD
Pan -10mg IV OD
Lasix -20mg IV BD
Optineuron-1amp IV OD
Vit-k-10mg IV OD
Doxy-100mg BD
Sporolac TID
Iv fluid
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