45yr old male, AMC bed 5

, HIV REACTIVE.

45 yr old male ,farmer by occupation came to the casualty with the cheif complaints of
1.ECHYMOTIC RASH since 1week over
    LEFT AND RIGHT THIGH , RIGHT FOREARM.
2. LEG PAINS since 2weeks.

HOPI:
Patient was apparently asymptomatic 2weeks back, then he developed bilateral leg pains ,not associated with fever, relieved on local rmp medication .

1week back he developed RASH in RIGHT THIGH FIRST, followed by LEFT THIGH AND RIGHT FOREARM, following which he went to hospital and incidentally found to have 
THROMBOCYTOPENIA.

NOT  a  k/c/o DM, HTN, asthma, TB, epilepsy.

No significant drug history.
No significant family history.

PERSONAL HISTORY:
He takes mixed diet , 
Appetite- normal
Regular bowel and bladder movements.
TAKES REGULAR ALCOHOL.

O/E:
pt is c/c/c.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy,edema.
No malnutrition.
No dehydration.

VITALS:
Afebrile temperature
PR: 80bpm.
BP: 160/110MMHG
RR:18CPM
SPO2: 98%
CVS: S1S2+
CNS: NAD
P/A: SOFT,NON TENDER, NAD.
RS: BAE+

INVESTIGATIONS:

HIV REACTIVE

HEMOGRAM:
Hb- 12.7
Tc- 5400
PL- 10000 

BLOOD GROUP- B POSITIVE

CUE:
Alb- nil
Sugar - nil
Pus cells- 2-3
Epi cells- 2-3

LFT:
TB: 0.70
DB:0.19
AST:33
ALT:45
ALP:217
TP:6.9
ALB: 3.3
A/G: 0.94

BLOOD UREA: 27

SERUM CREATININE: 0.8

SERUM ELECTROLYTES:
Na: 137
K: 3.7
Cl: 101

SERUM URIC ACID: 3.6

HIV REACTIVE
HBSAG,HCV : NON REACTIVE.

PROVISIONAL DIAGNOSIS:
THROMBOCYTOPENIA UNDER EVALUATION.

TREATMENT:
1. TAB. PCM 650MG SOS
2. plan for SDP TRANSFUSION if bleeding manifestations+
3. Watch for bleeding manifestations.
4. Tab. NICARDIA 5MG if SBP>160mmhg.






Popular posts from this blog

CKD ward, 38yr old male

Image
CKD WARD. 38yr old male , works in a book stall  HAS BEEN ON DIALYSIS SINCE 6YRS. Yesterday night he came with  c/o shorteness of breath ,pedal edema, abdominal distension and got admitted.  He cannot walk on his own, needs support. Yesterday's vitals: Bp:140/90mmhg RR: 28cpm Spo2: 98% RA. Today he has a dialysis session. His last dialysis was about a month ago He comes under day care basis usually. He has AV fistula to his left arm. H/O HTN since 2yrs on tab. NICARDIA 20mg. Today mrng at 9:00am his  BP : 190/110mmhg  RR: 26cpm After nebulization, sob decreased to some extent. RR: 20cpm. After giving NICARDIA 20mg oral ,  after 1hr his BP came down to 150/90mmhg. H/O alcohol since 20yrs, every alternate day around whiskey 200ml/day. Now since 2-3yrs he stopped consuming alcohol. He is a smoker since 20yrs, smokes around 20-30 cigarettes per day, before 6yrs. NOW HE SMOKES AROUND 10-12 CIGARETTES PER DAY No H/O DM, EPILEPSY, THYROID, TB ASTHMA. PAST HISTORY:...
Read more

28yr old female

Image
 25/10/21.  Currently in AMC. Today's OPD admission. A 28 year old woman, housewife by occupation presented to the opd with the complaints of Abdominal distension since 5 days Patient was born out of a second degree consanguineous marriage. Her father was also born out of a second degree consanguineous marriage. She has 2 elder sisters.  At 4 to 5 years of age she had jaundice for which she was given ayurvedic medications. She had recurrent episodes of jaundice for 3 years for which she kept consuming Ayurveda medications. She also experienced high coloured urine back then. She studied till her inter second year. She attained menarche at the age of 15 years. She gets regular menstrual cycles every 30 days lasting for 3 days. She changes around 2 to 3 pads per day. She got married in November 2020. It was a second degree consanguineous marriage.  In January 2021 - she experienced increased frequency of urine for which the patient visited a hospital where her RBS was ...
Read more

58yr OLD FEMALE, SSW

Image
23/11/21 58 YR OLD FEMALE , SSW came with c/o  Slurring of speech since 3days Deviation of mouth to left side  since 2days Weakness of Right UL,LL since 2days. Patient was apparently asymptomatic 3days ago, then she developed sudden onset of slurring of speech, observes by her daughter, when they checked her BP: 220/100mmhg. She was taken to a near by hospital, and was given medication TAB . CILIDIN - T. Patient's daughter observed weakness of Right UL initially, followed by right LL. K/C/O DM since 10yrs , on TAB. GLIMI -M  NOT a k/c/o HTN, ASTHMA,TB, EPILEPSY, THYROID. No similar complaints in the past. No significant family history. No known allergic history. Occupation: House wife Takes mixed diet Sleep is decreased Appetite is normal Bowel and bladder movements are normal. No any addictions O/E pt is C/C/C NO pallor, icterus, cyanosis,clubbing, lymphadenopathy, edema. No malnutrition No dehydration. VITALS: TEMP: 98.5F BP: 110/80mmhg PR: 84BPM RR: 18CPM GRBS: 251mg/d...
Read more