A 60yrs old female with c/o fever,vomitings,loose stools

A 60yr old nulliparous, postmenopausal female came to the hospital with C/O fever, vomitings, loose stools since 5days 

Patient was apparently asymptomatic 5days back then she developed high grade fever associated with chills and rigor ,relieved on medication  .

C/o  vomitings since 4days , non -projectile , content -food particles , 3-4 times a day .

C/o loose stools since 4days , 3-5 times a day , watery , no blood in stools .

C/o back pain and knee joint pain since onset of fever .

No c/o pain abdomen , cough, cold , burning micturition .

K/C/O psoriasis ( seasonal - exaggerated during summer ) 

Patient was  operated 15yrs back for right humerus, radius & ulna  fractures  for which ORIF was done .

H/o blood transfusion 15yrs back during ORIF operation 

Past history : 

Not a k/c/o HTN, DM,TB, Asthma , Epilepsy , CAD 

Family history - not significant.

Personal history -

Diet -mixed 

Appetite - decreased 

Bowel & bladder movements - regular 

Occasional toddy consumer 

GENERAL EXAMINATION :

Patient is conscious , coherent , co operative .

No pallor , icterus, cyanosis , clubbing , lymphadenopathy , edema

VITALS :

Temp - Afebrile 

BP -130/70 mmHg

PR - 78 bpm.

RR - 15 cpm

SpO2 - 99%@ RA

SYSTEMIC EXAMINATION 

CVS - S1 S2 + , no murmurs 

RS - NVBS + , BAE + 

P/A - soft , non tender , BS +

CNS - NAD 

PROVISIONAL DIAGNOSIS 

NS1 positive 

Viral pyrexia

Thrombocytopenia

Investigations

Treatment

IVF - NS     at 100ml/hr

   |

  RL

Inj. PANTOP 40mg IV/OD

Inj. ZOFER 4mg IV/SOS

Inj. NEOMOL 100ml IV/SOS (if temp. - 101°F)

Plenty of oral fluids

Tab. PCM 500mg PO/TID

Monitor Postural hypotension

W/f bleeding manifestations

Strict I/O to temp. charting

GRBS - 6th hourly

Soap note 

16/12/21

Ward 

60 year old female 

S-

C/0 giddiness and vomitings (2 episodes ) only while sitting 

O- 

Pt is c/c/c 

Afebrile

Bp-supine - 120/70 mmHg

Standing - 110/70 mmHg

Rr-17 cpm

Spo2 -99%

CNS - nad 

Rs- bae + 

P/a - soft ,non tender 

A- ns1 positive with viral pyrexia with thrombocytopenia 

P-

1.ivf -ns ,rl @100 ml/hr 

2.inj pan 40 mg IV/of

3.inj Zofer 4 mg IV TID 

4.inj Neomol 100 ml iv sos 

5.tab pcm 500 mg po tid 

6.monitor postural hypotension 

7.watch for any bleeding manifestations 

8.strict I/o charting 

9.grbs 6th hourly