42 YEAR OLD FEMALE ? MENINGOENCEPHALITIS? VIRAL / TUBERCULAR
UNIT 2 ADMISSION (2/3/21)
LFT RFT
URINE C/S
DR ASHA ( INTERN
DR AMULYA (INTERN)
DR YAMINI (INTERN)
DR JAYANTH (INTERN)
DR PRADEEP ( INTERN)
DR VAMSHI (INTERN)
DR ISMAIL (INTERN)
DR PRADEEP ( PG 1ST YEAR)
DR DIVYA (PG 2ND YEAR)
DR SUFIYA (PG 3RD YEAR))
DR SATISH (PG 3RD YEAR)
A 42 YEAR OLD FEMALE PATIENT FARMLABOURERBYOCCUPATION C/ O FEVER SINCE 5 DAYS , ALTERED SENSORIUM SINCE 3 DAYS , IRRELEVANT TALKING SINCE 4 DAYS , PATIENT HAD INVOLUNTARY MOVEMENTS OF RT UPPER LIMB TODAY , FOR WHICH SHE WAS BROUGHT TO HOSPITAL
PATIENT WAS APPARENTLY ASYMPTOMATIC 5 DAYS BACK , SHE HAD NO OTHER COMPLAINTS OR NO HOSPITAL TREATMENT / VISTS BEFORE .
PATIENT DEVELOPED FEVER SINCE 5 DAYS HIGH GRADE , INTERMITTENT ,ASSOCIATED WITH CHILLS AND RIGORS . RELIEVED WITH MEDICATION ON RMP TREATMENT
PATIENT HAD 2 EPISODES OF VOMITING ON DAY 1 OF FEVER SUBSIDED WITH MEDICATION , SHE ALSO COMPLAINTS OF HEADACHE WHEN SHE WAS WELL. THEN PATIENT STARTED TO TALK IRRELEVANT LY SINCE 4 DAYS, AND TALKING TO HERSELF, LATER PATIENT IS CONFUSED AND NOT RESPONDING TO HER FAMILY MEMBERS COMMANDS AND HER SENSORIUM GOT WORSENED .
PATIENT WAS ACTIVE 5 DAYS BACK AND USED TO DO HER DAILY ACTIVITIES . SHE HAD NO OTHER COMPLAINTS AND NO HOSPITAL VISTS BEFORE ,
NOT A K/C/ O DM , HTN, ASTHAMA, EPILEPSY, CAD,LVA.
O/ E
PATIENT WAS CONCIOIOUS, AND ALTERED SENSORIUM , DROWSY BUT AROUSABLE GCS E4V1M4
B/L PUPIL REACTING TO LIGHT
EXAMINATION
NO SIGNS OF PALLOR, ICTERUS, CLUBBING, CYANOSIS, GENERALIZED LYMPHADENOPATHY, EDEMA .KOILONYCHIA
BP - 130/90 MMHG
PULSE - 94 BPM
RR - 21 CPM
SPO2 - 97% @ ROOM AIR
GRBS - 112 MG
CVS - S1,S2 +
RR- B/L AIR ENTRY PERESNT , NORMAL VESICULAR BREATH SOUNDS IN ALL LUNG FEILDS
ABDOMEN - SOFT NON TENDER , BOWEL SOUNDS HEARD
CNS - HEIGHER MENTAL FUNCTIONS ARE INTACT
CNS
NOT ORIENTED TO TIME, PLACE, PERSON
HYPERTONIA IN ALL FOUR LIMBS
EXAGGERATED REFLEXES IN BOTH UL AND LL
NECK STIFFNESS +?
CANNOT ELICIT OTHER SIGNS DUE TO HYPERTONIA
INVESTIGATION S
HEMOGRAM ,CUE , ECG , MRI BRAIN , FUNDOSCOPY, USG ,HBsAG RAPID, HIV 1/2 RAPID, ANTI HCV ,LFT, RFT ,ABG., X RAY.
LUMBAR PUNCTURE DONE
ECG
ABG
ABG ON. (4/3/21)
X-RAY
FUNDOSCOPY - NO FEATURES OF RAISED ICT
LUMBAR PUNCTURE
CSF ANALYSIS, NEUTROPHILS 10 %, LUMPHOCYTES 90 %, (SUGAR, PROTIEN, CHORIDE LEVELS NORMAL)
CSF. C/S
Blood C/S
Fever chart
TEMP CHARTING till 10/3/21
THYROID PROFILE (4/3/21)
DIGNOSIS
?VIRAL ENCEPHALITIS
?METABOLIC ENCEPHALITIS
TREATMENT
DAY 1(2/3/21)
1) INJ PAN 40MG IV OD
2) INJ ZOFER 4 MG IV / BD
3 ) INJ CEFTRIAXONE 2 G/IV / BD
4) INJ NEOMOL 1GM IV / STAT / SOS / IF TEMP >101 DEGREE F
5) INJ PHENYTOIN 100 MG IV / TID
6 )INJ OPTINEURON 1AMPULE IN 100 ML NS / IV / OD
7) RT FREDS 4 TH HOURLY , 3 SPOONS OF PROTIEN POWDER IN 1 GLASS OF MILK + FREE WATER
8) 1 UNIT NS , 1 UNIT RL, 1 UNIT DNS @75 ML / HR
9)INJ MANITOL 100ML IV /TID
10 ) INJ DEXA 8MG IV / TID
DAY 2 (3/3/21)
S
- PATIENT HAD 1 FEVER SPIKE AT 8:AM ,NOT PASSED STOOLS, NO IMPROVEMENT IN SENSORIUM
PATIENT IS CONCIOUS , ALTERED SENSORIUM , DROWSY BUT AROUSABLE ,
GCS- E4, V1,M4
CNS HYPERTONIA IN ALL 4 LIMBS (LT >RT) , EXAGGERATED REFLEXES, PLAN TAR EXTENSOR RESPONSE
1) IVF. 1 UNIT NS,DNS 75ML/ HR
2)INJ PAN 40 MG IV/ OD
3)INJ ZOFER 4 MG IV / BD
4) INJ CEFTRIAXONE 2 GM IV / BD
5) INJ ACYCLOVIR 500MG IV / TID
6)INJ FALCIGO 120 MG IV STAT ATV9:00 AM ---------120MG IV STAT, ( TOMMOROW 9AM )
7)INJ DEXA 8 MG IV, /TID
8)INJ MANNITOL 100ML IV/TID
9)INJ PHENYTOIN 100MG IV /TID
10)INJ OPTINEURON 1 AMP IN 100 ML NS IV/OD
11)RT FEEDS 3 SCOOPS PROTIEN POWDER IN 1 GLASS OF MILK + FREE WATER 50 ML
12) BP, PR, RR, SPO2 MONITORING
13)GRBS AND I/O
14) TIPID SPONGING SOS
15) CHANGE POSITION EVERY 2 ND HOURLY
16)TAB PCM PO/TID (1-------1-------1)
DAY3 (4/3/21)
S
PATIENT HAD 5 SPIKES OF FEVER ,1 AM , 2PM ,
PATIENT NOT PASSED STOOLS SINCE 2 DAYS
NO IMPROVEMENT IN SENSATION
O
PATIENT IS UNCONSCIOUS
DROWSY ,NOT AROUSABLE
GCS E 1 V1 M4
B/L PUPIL REACTING TO LIGHT
BP 140/ 90MMHG
PR 91 BPM
RR 29CPM
SPO2 98 %@3 L OF O2
GRBS 121MG / DL
CVS- s1 s2 HEARD
RS - B/ L AIR ENTRY PERESNT , NVBS
P/A - SOFT, NON TENDER, BOWEL SOUNDS +
CNS - TONE IMPROVED IN BOTH LIMBS. EXAGGERATED REFLEXES, PLAN TAR EXTENSOR RESPONSE
A
VIRAL ENCEPHALITIS, ? METABOLIC ENCEPHALOPATHY
P
1 ) 1 UNIT NS,RL,DNS @75ML/ HR
2) INJ PAN 40MG IV / BD
3)INJ ZOFER 4MG IV/BD
4) INJ ACYCLOVIR 500MG IN 100ML NS IV/TID OVER 1 HOUR
5) INJ FALCIGO 120MG IV STAT AT 9: AM
6) INJ DEXA 8 MG IV TID
7) INJ MANITOL 100ML IV / TID
8) INJ PHENYTOIN 100MG IV/TID
9)INJ OPTINEURON 1AMPULE IN 100ML NS IV/OD
10 ) RT FEEDS 3 SCOOPS PROTIEN POWDER + 1 GLASS OF MILK + FREE WATEr - 4 TH HOURLY
11) BP, PR, RR, SPO2 MONITORING
12) GRBS , I/O CHARTING
13) TIPID SPONGING SOS
14) CHANGE POSITION EVERY 2ND HOURLY
Day 7 (8/3/21)
S
PATIENT IS OPENING EYES TO STIMULUS .NOT PASSED STOOLS
O
GCS E2V1M4
B/L PUPIL REACTING TO LIGHT
BP. 100/80MMHG
PR 95 BPM
RR 30 CPM
TEMP 101.6 DEGREE F
SPO2 94 %ROOM AIR
GRBS- 135 mg
CVS - S1 S2 HEARD,
RS - B/L AIR ENTRY PERESNT, NVBS
P/A - SOFT, NON TENDER, BOWEL SOUNDS +
CNS -
TONE- HYPERTONIA IN ALL LIMBS
POWER
RT. LT
UL. 0/5. 1/5
LL. O/5. 0/5
REFLEXES
RT. LT
B. + VE _VE
T. -VE. - VE
S. + VE. - VE
K. - VE. - VE
A. - VE. -VE
PLANTAR. EXTENSOR
A
MENINGOENCEPHALITIS, ? VIRAL ? TUBERCULAR.
P
1) 1 UNIT NS,RL, DNS, @75ML/ HR
2) INJ PAN 40MG IV/BD
3)INJ ZOFER 4MG IV/BD
4) INJ ACYCLOVIR 500MG IN 100ML NS IV/TID
5) INJ. FORTUM 2 MG /IV/TID
6)INJ DEXA 8 MG IV/TID
7) INJ MANNITOL 100 ML IV/TID
8)INJ FALCIGO 120MG IV STAT
6)INJ DEXA 8MG IV TID
7) INJ MANITOL 100ML IV/TID
8)TAB ATT PO/OD
9)INJ PHENYTOIN 100MG IV/BD
10) INJ NEOMOL 1 GM IV/SOS IF TEMP 101.DEGREE F
11)INJ VIT K 10MG /OD
12) INJ OPTINEURON 1AMPULE IN 100ML NS IV/ 10
13)RT FREDS 3SCOOPS PROTIEN
14) BP ,PR, RR,SPO2 MONITORING
15) GRBS I/0 CHARTING
16) TIPID SPONGING SOS
17) CHANGE POSITION EVERY 2ND HOURLY
18)NEBULIZATION WITH NS 4TH HOURLY
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