VIRAL PYREXIA WITH BICYTOPENIA WITH ACUTE GASTROENTRITIS K/C/O HYPOTHYROIDISM SINCE 15 YEARS K/C/O DM II SINCE 20 YRS

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51 YR OLD MALE WITH C/O FEVER SINCE 3 DAYS

C/O VOMITINGS 2 DAYS BACK

HOPI:

PT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK THEN HE DEVELOPED HIGH GRADE FEVER,CONTINUOUS, NO DIURUINAL VARIATION ASS WITH CHILLS RIGORS.ASS HEADACHE , GENERALISED PAINS

NO H/O COUGH,COLD,THROAT PAIN

H/O EPISODES OF VOMITINGS,BIIOUS,NON PROJECTILE ON FIRST DAY FEVER

NO H/O PAIN ABDOMEN,HEMATURIA,ABDOMINAL DISTENSION

H/O SOB GRADE 2

H/O LOSS OF APPETITE

PAST HISTORY:

K/C/O DM SINCE 20 YRS ON GLYCOMET SR PO/OD

K/C/O HYPOTHYROIDISM SINCE 15 YRS ON THYRONORM 50 MCG

N/K/C/O CAD,CVA,ASTHMA,TB

GENERAL EXAMINATION:

PT IS CCC

NO SIGNS OF PALLOR,CYANOSIS,CLUBBING,LYMPHADENOPATHY

PR 76 BPM

BP 130/80 MMHG

SPO2 98

RR 22 CPM

SYSTEMIC EXAMINATION:

CVS S1 S2 HEARD

RS BAE+

GIT SOFT NT

CNS NFND

INVESTIGATION:

BLOOD UREA   15-12-2023 06:13:PM 3.3 mg/dl 42-12 mg/dl	SERUM CREATININE   15-12-2023 06:13:PM 1.4 mg/dl 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   15-12-2023 06:13:PM   SODIUM 135 mEq/L 145-136 mEq/L  POTASSIUM 3.7 mEq/L 5.1-3.5 mEq/L  CHLORIDE 98 mEq/L 98-107 mEq/L  CALCIUM IONIZED 1.01 mmol/L mmol/L	COMPLETE URINE EXAMINATION (CUE)   15-12-2023 06:13:PM   COLOUR Pale yellow    APPEARANCE Clear    REACTION Acidic    SP.GRAVITY 1.010    ALBUMIN ++++    SUGAR Nil    BILE SALTS Nil    BILE PIGMENTS Nil    PUS CELLS 3-6    EPITHELIAL CELLS 2-4    RED BLOOD CELLS Nil    CRYSTALS Nil    CASTS Nil    AMORPHOUS DEPOSITS Absent    OTHERS Nil
HBsAg-RAPID   15-12-2023 08:58:PM Negative	Anti HCV Antibodies - RAPID   15-12-2023 08:58:PM Non Reactive
LIVER FUNCTION TEST (LFT)   16-12-2023 07:37:AM   Total Bilurubin 1.25 mg/dl 1-0 mg/dl  Direct Bilurubin 0.24 mg/dl 0.2-0.0 mg/dl  SGOT(AST) 22 IU/L 35-0 IU/L  SGPT(ALT) 13 IU/L 45-0 IU/L  ALKALINE PHOSPHATE 135 IU/L 128-53 IU/L  TOTAL PROTEINS 8.3 gm/dl 8.3-6.4 gm/dl  ALBUMIN 4.3 gm/dl 5.2-3.5 gm/dl  A/G RATIO 1.11	POST LUNCH BLOOD SUGAR   16-12-2023 08:38:AM 124 mg/dl 140-0 mg/dl
T3, T4, TSH   16-12-2023 08:39:AM   T3 0.44 ng/ml 1.87-0.87 ng/ml  T4 2.19 micro g/dl 12.23-6.32 micro g/dl  TSH 1.42 micro Iu/ml 5.36-0.34 micro Iu/ml	POST LUNCH BLOOD SUGAR   16-12-2023 10:37:PM 140 mg/dl 140-0 mg/dl
BLOOD UREA   17-12-2023 06:23:AM 30 mg/dl 42-12 mg/dl	SERUM CREATININE   17-12-2023 06:23:AM 1.5 mg/dl 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   17-12-2023 06:23:AM   SODIUM 138 mEq/L 145-136 mEq/L  POTASSIUM 4.1 mEq/L 5.1-3.5 mEq/L  CHLORIDE 98 mEq/L 98-107 mEq/L  CALCIUM IONIZED 1.10 mmol/L mmol/L

USG ABDOMEN :

MILD HEPATOMEAGLY

GRADE 1 FATTY LIVER

MILD SPLENOMEAGLY

DIAGNOSIS:

VIRAL PYREXIA WITH BICYTOPENIA WITH ACUTE GASTROENTRITIS

K/C/O HYPOTHYROIDISM SINCE 15 YEARS

K/C/O DM II SINCE 20 YRS

TREATMENT:

INJ NEOMOL 1 GM IV/STAT

INJ CEFTRIAXONE 2GM IV/BD

INJ PAN 40 MG IV/OD

INJ ZOFER 4MG IV SOS

TAB PCM 650 MG PO/TID

TAB THYRONORM 50 MCG PO/OD

TAB METFORMIN 500 MG /PO/OD

ADVICE AT DISCHARGE:

CAP DOXYCYCLINE 100 MG PO/BD

TAB SPOROLAC PO/TID

CAP DOXYCYCLINE 100 MG PO/BD 2 DAYS

TAB PCM 650 MG PO/SOS

TAB THYRONORM 50 MCG PO/OD

TAB METFORMIN 500 MG /PO/OD