50 yrs old F with fever and chills following MHD

December 04, 2022

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment

CHIEF COMPLAINTS:

50 year old female , came to medicine department with complaints of pedal edema, shortness of breath and decreased urine output.

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 8 months later developed,

BILATERAL PEDAL EDEMA with BILATERAL HAND EDEMA,

Then she was admitted in Nalgonda hospital , where she was given drugs for 5 days but there was no improvement, and referred to hyderabad hospital .

She was diagnosed with CKD and started dialysis for 2 months, but due to transport and financial problems she was brought into our hospital

Since 6 months , she is undergoing MHD here

On 25/11/2022, she came for routine day care dialysis at 10:00 am .

11:00 am she was on MHD , after an hour she developed , High grade fever (104°F) a/w fever , chills, lower back pain and neck pain, shortness of breath, 1 episode of non projectile and non bilious vomit , with food particles as contents.

She was shifted to ICU.

Around 7pm @ 25th Nov

Signs of Dehydration: dryness of mouth,back pain & generalised weakness,BP-70/50mm Hg

200ml fluid given

Bp- 90/60mmHg then in 30 mins. Bp-80/50 mm Hg

Inj. Noard was given 4-6 mlwith maintenence fluid 30ml/ hr

26th Nov

BP - 100/60 mm Hg

Inj, Norad

Nausea, generalised weakness , low grade fever 99°F

650 MG PCM was given

Persistent tachycardia was seen

PR-115-120bpm

BP-80/60mm Hg

2D ECHO results - good LV infusion, No RWMA, LVH+, Moderate MR+/TR+ , PAH

X-ray - Minimal pericarditis effusion

Iv fluid was held and inj. Dobutamine was started.

BP -100/60 mm Hg

HR- 117BPM

TEMP. - 97°F

SpO2- 99%

nausea , generalised weakness and low grade fever was present.

No history of cough , burning micturition, abdominal pain.

PAST HISTORY:

No similar complaints

History of hypertension since 3 years

History of diabetes since 15 years

No history of epilepsy , tuberculosis , Coronary artery disease

PERSONAL HISTORY:

She wakes up at 5:30am , goes to field , has her tea at 8 am then returns back to work, come back at 12:30 pm , she has her lunch and rest . Continues work till 5pm , does household chores and she sleeps by 10 pm.

But her daily routine is disturbed since 8 months .

She consumes mixed diet , appetite is normal, sleeps adequate , bowel and bladder movements are regular . No addictions.

FAMILY HISTORY