A 45 year old male with Urosepsis

 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)

HOPI 

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

His daily routine did not disturb even after he developed the illness

PAST HISTORY

No similar complaints in the past

Personal history

Diet:mixed 

Appetite: increased

Sleep: adequate 

Bowel (loose stools)and bladder(irregular)

Addictions: Alcohol since 25 yrs (180ml/day)

FAMILY HISTORY:No significant family history

DRUG HISTORY:No history of allergy to any drugs 

GENERAL EXAMINATION

Patient was conscious coherent and cooperative

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  20 cpm

GRBS 578 mg/dl on the day of admission 

 249 mg/ dl on 2/ 08/2022

Systemic Examination

CENTRAL NERVOUS SYSTEM 


Higher mental functions intact

Cranial nerve examination intact

SUPERFICIAL REFLEXES:.         Right.      Left

Corneal reflex                                  present

Conjunctival reflex.                         Present

              DEEP TENDON 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


Signs of meningeal irritation  neck stiffness present 







RESPIRATORY SYSTEM


Inspection: 


Shape of chest: Pectus excavatum


No scars and sinuses 


Trachea central


Palpation:


Inspectory findings are confirmed


Palpable sounds are felt


Percussion: 


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 
















 

 

 






3 dialysis sessions are done
31/07/2022
1/08/2022
3/08/2022



DIAGNOSIS 
Urosepsis with Diabetes



Treatment:

Pan 10mg IV OD

Vitamin K 10mg OD

Optineurin 1amp IV OD

Doxy 100mg BD

Meropenem 500mg IV BD

Sporolac TID 

On 6/08/2022





















































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