A 55 yr old female with fever and yellowish discoloration of eyes

 

A 55yr old female resident of thondlai came with chief complaints of fever , yellowish discoloration of eyes since 20 days.

generalized weakness and dizziness 3 days .

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 20 days back and then she developed fever which was intermittent (4 or 5 times since 20 days) and evening rise of temperature was seen for which she took paracetamol and it subsided .fever was not associated with chills and rigors.

She also had yellowish discoloration of eyes and urine since 20 days .

She also complains of burning micturition.

she came to our hospital on and was asked to get admitted but due to financial problems their family denied it.

Treatment advised was- tab Udiliv 300mg BD,

Tab Dolo 650mg sos, continue antihypertensive and anti diabetic medications.

And then she took herbal medicines every monday for 2 weeks and stopped anti diabetic and anti hypertensive medications completely since 1 week(when she started taking herbal medications)

 Since 3 days she had generalized weakness and dizziness for which again she came to our hospital.

Patients daily routine

Gets up at around 6 am and does house hold work and stays at home all the day. she will have break fast around 9 am and lunch at 1 PM and dinner at 8 pm And sleeps around 9 pm .

She stopped doing any work since 20 days

PAST HISTORY

History of diabetes and hypertension since 5 yrs 

No history of TB asthma epilepsy , chronic disease

FAMILY HISTORY

No significant family history



PERSONAL HISTORY

Diet: mixed

Appetite normal

Sleep adequate

Bowel and bladder regular

Addictions alcohol occasionally


TREATMENT HISTORY

Using Amlodipine for hypertension

And glimiperide, metformin for diabetes

Since 5 years 


GENERAL EXAMINATION

Patient is conscious, coherent and cooperative.

Well oriented to time place person

Moderately built and moderately nourished


No pallor

Icterus present

No cyanosis

No clubbing

No generalised lymphadenopathy

No edema



VITALS

PR: 80bpm

RR: 16cpm

TEMP :Afebrile

BP: 140/90mmhg

SP02 :99%



SYSTEMIC EXAMINATION

RS: Bilateral air entry present 

Normal vesicular breath sounds heard


CVS : S1 S2 heard, no murmurs

CNS: No focal neurological deficit

PA:

  No abdominal distension

   No tenderness

   Umbilicus- normal

   Movements -moves with respiration

   No sinuses, distended veins

   Scar of hysterectomy 20yrs back

   No palpable mass

   Liver is palpable

   Spleen is not palpable

   Bowel sounds heard

   











INVESTIGATIONS

Hemogram 

Hemoglobin 12.7/dl

RBC count 4.27 million/mm3 

Platelets 2.07/mm3 

Total count 10000/mm3 

Eosinophils 04%

Basophils 00

Neutrophils 58%

Monocytes 10

Lymphocytes 28 

PCV 38 vol % 

MCV 90.4 fl

MCHC 30 % 

MCH 30 pg

Liver function tests 

Direct bilirubin 15.9mg/dl

Indirect bilirubin 10.9mg/dl

SGOT 1172IU/L

SGPT 795 IU/L

Alkaline phosphatase 456IU/L

Total protein 6.9g/dl

Albumin 3.55g/dl

A/G ratio 1.06

Serum electrolytes

Sodium 138mEq/L 

Potassium 4 mEq/L 

Chloride 102 mEq/L 

Blood urea 20 mg /dl 

Serum creatinine 0.6mg/dl 

HbsAg Rapid Negative 

Anti-HCV antibodies Non reactive 

Complete Urine Examination

Colour  pale yellow

Appearance clear

Reaction Acidic

Specific gravity  -1.010

Albumin Nil

Sugar Nil

Bile salts Nil

Bile pigments 

Pu s cells 1-2

Epithelial cells 2-3

Red blood cells Nil

Crystals Nil

Casts Nil

Amorphic deposit Nil



2D ECHO


ECG




PROVISIONAL DIAGNOSIS

               TOXIN INDUCED HEPATITIS



TREATMENT

1. Inj Pantop 40mg OD IV

2. Inj Zofer 4mg IV

3. Inj Neomol 1gm IV

4. Tab PCM 500mg BD

5. Tab Rifagut 550mg

6. Inj Trenexa 500mg IV stat

7. Tab Udiliv 300mg BD

8. Syrup Lactulose

9. Syrup Aristrozyme 25ml TID

10. Protein rich diet

11. Temperature charting ,GRBS monitoring .




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