CBBLE UDHC similar cases

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 box

55 year old male  who is a farmer came to casuality with alleged history of seizure activity on 28/2/22 for which he was admitted in a hospital where he was resuscitated and intubated  after having cardiac arrest on day 2 (4 am) of his stay at the hospital.

HISTORY OF PRESENTING ILLNESS : 

Patient was apparently asymptomatic 6 years back then he suffered with sudden onset seizure activity which lasted for 8- 10 minutes ON 28/2/2022 . 

He had h/o involuntary movements of upper limb and lower limb with uprolling of eyes along with aura ,involuntary micturition and defecation, tongue bite,  post ictal confusion.

He was rushed  to a nearby hospital and was treated conservatively .During the stay in the hospital patient had cardiac arrest on day 2 of admission at 4 a.m. was intubated and put on mechanical ventilator and referred to us in view of of their affordability issues. 

History of fever since 3 days.

PAST HISTORY:

k/c/o seizures since 6 years.

History of trauma to head 10 years back (fall from bike ) ,no chief complaints of LOC, headache, seizures giddiness.

H/o seizure attack 6 years back for which he was treated with levipril.

1 year back  he had another seizure activity since then he was advised to take regular medication ( levipil) to avoid future seizure activity but the patient didn't take regular medication.

Not a known case of  DM and HTN. 

PERSONAL HISTORY: 

Alcoholic since 15 years  , tobacco smoking since 30 years

GENERAL EXAMINATION:

O/E : patient is on mechanical ventilator

         FiO2 - 40%

          PEEP- 5

           VT - 420

          GCS: E1 VT M2

Pallor - present

Icterus  absent

Cyanosis - absent

Edema of feet - present

Lymphadenopathy  - absent

Clubbing - absent

VITALS:

Temperature: 100 F

 BP: 140/80mmhg 

  PR: 112 bpm 

  RR : 18CPM

   SYSTEMIC EXAMINATION:       

CNS:

Pupils -          B/L NSRL

Reflexes:            

      Biceps           2+                   2+

      Triceps          2+                   2+

      Supinator      2+                   2+

      Knee             3+                   3+

      Ankle             -                      -

      Plantar         flexion         flexion

CARDIOVASCULAR SYSTEM : S1 and S2 heard, no murmurs heard 

RESPIRATORY SYSTEM : BAE present

P/A : soft

INVESTIGATIONS:

5/3/22

BGT: B POSITIVE

6/3/22

SPOT URINE PROTEIN: 7

SPOT URINE CREATNINE: 74

RATIO: 0.09

PROVISIONAL DIAGNOSIS:

 SEIZURE UNDER EVALUATION (? ALCOHOL WITHDRAWAL SEIZURE)  ? HYPOXIC ENCEPHALOPATHY POST CPR STATUS DAY 5 

TREATMENT: 

HEAD AND ELEVATION UP TO 30%

INJ. MEROPENEM 1 G IV BD

 INJ. LEVIPIL 500 MG IV BD 

INJ MIDAZOLAM 10 MG IN 50 ML NS @ 30 ML/ hr INJ. MANNITOL 100 ML IV BD

INJ. PANTOP 40 MG IV OD

INJ. NEOMOL 100 ML IF TEMPERATURE >  101 F INJ THIAMINE 2 AMP  IN ONE DNS IV BD

SOAP NOTES:

DAY 2(7/3/22)

S:- Fever spikes present  

O: patient is on mechanical ventilator

          PEEP- 5

          FiO2 - 40% 

          VT - 400ml

          VITALS:

temp- febrile

BP 140/80 mm hg 

PR 130 bpm. 

RR 18 cpm 

spo2: 92% with Fio2 40%

CVS - S1, S2 heard ,muffled heart sounds

RS. :- NVBS Present, no crepts

P/A: soft, non tender 

CNS: Pupils :B/L NSRL 

REFLEXES :     right             left 

       Biceps.          2+               2+

       Triceps          2+               2+

       Supinator       2+              2+

       Knee               -                 - 

       Ankle              -                -

       Plantar          mute            mute

A:- Seizures secondary to ? tuberculoma /NCC ?alcohol with hypoxic encephalopathy with post CPR status day 7 , mechanical ventilator day 6

Day 3:(8/3/22)

S:- no fever spikes

O- O/E : patient is on mechanical ventilator

          PEEP- 5

          FiO2 - 40% 

          VT - 400ml

          Timp : 2.1

          VITALS:

temp- afebrile

BP: 110/90mm hg 

PR: 115 bpm. 

RR: 16 cpm 

spo2: 99% with Fio2 40%

GRBS: 168 mg/dl

CVS - S1, S2 heard ,no murmurs

RS. :- NVBS Present, no crepts

P/A: soft, non tender 

CNS: Pupils :B/L NSRL 

GCS: E1VTM2

Cough reflex present

corneal reflex present

conjunctival reflex present

REFLEXES :      right         left 

       Biceps            2+             -

       Triceps           2+            2+

    Supinator          2+            2+

       Knee              3+            3+ 

      Ankle               -               -

      Plantar            mute       mute

A: Seizures secondary to ? tuberculoma /NCC ?alcohol with hypoxic encephalopathy with post CPR status day 8 , mechanical ventilator day 7

P: ENT opinion i/v/o tracheostomy

Day 4:(9/3/22)

S:- fever spikes present

O- O/E : patient is on mechanical ventilator

          PEEP- 5

          FiO2 - 40% 

          VT - 400ml

          Timp : 2.1

          VITALS:

temp- 100.9 F

BP: 120/90mm hg @ NORAD 6ml /hr

PR: 114 bpm. 

RR: 16 cpm 

spo2: 99% with Fio2 40%

GRBS: 129 mg/dl

CVS - S1, S2 heard ,no murmurs

RS. :- NVBS Present, no crepts

P/A: soft, non tender 

CNS: Pupils :B/L NSRL 

GCS: E1VTM1

Cough reflex present

corneal reflex present

conjunctival reflex present

REFLEXES :       right                  left 

       Biceps             2+                     2+

       Triceps            2+                     2+

    Supinator           2+                     2+

       Knee               3+                     3+ 

      Ankle                -                        -

      Plantar             extensor            extensor

A: Seizures secondary to ? tuberculoma /NCC ?alcohol with hypoxic encephalopathy with post CPR status day 9 , mechanical ventilator day 8

Day 5(10/3/22):

S:- no fever spikes 

O- O/E : patient is on mechanical ventilator

          PEEP- 7

          FiO2 - 40% 

          VT - 400ml

          Timp : 2.6

          VITALS:

temp- Afebrile

BP: 90/50mm hg @ NORAD 8ml /hr

PR: 109 bpm. 

RR: 14 cpm 

spo2: 99% with Fio2 40%

GRBS: 181 mg/dl

CVS - S1, S2 heard ,no murmurs

RS. :- NVBS Present, no crepts

P/A: soft, non tender

CNS: Pupils :B/L NSRL 

GCS: E1VTM1

Cough reflex present

corneal reflex present

conjunctival reflex present

REFLEXES : right. left 

       Biceps   2+                   2+

       Triceps . 2+                  2+

    Supinator  2+                 2+

       Knee        2+              2+ 

      Ankle      -                  -

      Plantar    extensor    extensor

A: Seizures secondary to ? tuberculoma /NCC ?alcohol with hypoxic encephalopathy with post CPR status day 10, mechanical ventilator day 9

Day 6 (11/3/22):

S:- no fever spikes 

O- O/E : patient is on mechanical ventilator

          PEEP- 7

          FiO2 - 40% 

          VT - 400ml

          Timp : 1.9

          VITALS:

temp- Afebrile

BP: 140/80mm hg @ NORAD 10ml /hr,vaso 2ml/hr

PR: 73 bpm. 

RR: 14 cpm 

spo2: 99% with Fio2 40%

CVS - S1, S2 heard ,no murmurs

RS. :- NVBS Present, no crepts

P/A: soft, non tender

CNS: Pupils :B/L sluggish reaction to light

GCS: E1VTM1

corneal reflex present

conjunctival reflex present

REFLEXES : right. left 

       Biceps   2+                   2+

       Triceps . 2+                  2+

    Supinator  2+                 2+

       Knee        2+              2+ 

      Ankle      -                  -

      Plantar    extensor    extensor

A: Seizures secondary to ? tuberculoma /NCC ?alcohol with hypoxic encephalopathy with post CPR status day 11, mechanical ventilator day 10

P: MRI

Day 7 (12/3/22):

S:- no fever spikes 

O- O/E : patient is on mechanical ventilator

          PEEP- 6

          FiO2 - 30% 

          VT - 460ml

          Timp : 1.9

          VITALS:

temp- Afebrile

BP: 150/70mm hg 

PR: 79 bpm. 

RR: 17cpm 

GRBS: 149mg/dl

spo2: 99% with Fio2 30%

CVS - S1, S2 heard ,no murmurs

RS. :- NVBS Present, no crepts

P/A: soft, non tender

CNS: Pupils : NSRL

GCS: E2VTM2

cough reflex: present

corneal reflex :negative

conjunctival reflex: present

doll's eye: negative

REFLEXES : right. left 

       Biceps   3+                   3+

       Triceps . 3+                  3+

    Supinator  3+                 3+

       Knee        3+              3+ 

      Ankle      3+                 3+

      Plantar    extensor    extensor

A: Seizures secondary to ? tuberculoma/?NCC with chronic hypoxic encephalopathy with post CPR status day 12, mechanical ventilator day 11

P : EEG

Day 8 (13/3/22):

S:- no fever spikes 

O- O/E : patient is on mechanical ventilator

          PEEP- 6

          FiO2 - 25% 

          VT - 400ml

          Timp : 1.9

          VITALS:

temp- Afebrile

BP: 130/90mm hg @NORAD 4ml/hr

PR: 112 bpm. 

RR: 14cpm 

GRBS: 157mg/dl

spo2: 99% with Fio2 25%

CVS - S1, S2 heard ,no murmurs

RS. :- NVBS Present, no crepts

P/A: soft, non tender

CNS: Pupils : NSRL

GCS: E2VTM2

cough reflex: present

corneal reflex : present

conjunctival reflex: present

doll's eye: negative

REFLEXES : right. left 

       Biceps   3+                   3+

       Triceps . 3+                  3+

    Supinator  3+                 3+

       Knee        3+              3+ 

      Ankle      3+                 3+

      Plantar    extensor    extensor

A: Seizures secondary to ? tuberculoma/?NCC with severe hypoxic ischemic injury with post CPR status day 13, mechanical ventilator day 12

CBBLE UDHC similar cases

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 box

A 39 year old male patient is on maintenance haemodialysis since 2 years.

HOPI: 

Patient was apparently asymtomatic 2 years back and then developed shortness of breath (on and off), pedal oedema (pitting type), pain abdomen, squeezing type, headache and dizziness. Later diagnosed as chronic renal failure and underwent dialysis twice weekly Last year a few times he underwent dialysis thrice weekly. Presently he is undergoing dialysis twice weekly.

PAST HISTORY: 

k/c/o HTN since 3 years.

Not a K/C/O of DM, thyroid disorders, TB

PERSONAL HISTORY: 

He follows a mixed diet. Appetite -Normal, Bladder movements-normal

Bowel movements-normal since few weeks. Sleep- decreased.

consumes alcohol occasionally and stopped 2 years back.

FAMILY HISTORY: 

No significant family history

.

DRUG HISTORY: 

No known drug allegies and patient uses amlodipine 5mg,arkamin clonidine 100mcg,metxl 25mg.

GENERAL EXAMINATION:  

Patient is conscious ,coherent, co operative and well oriented to his surroundings.

He is poorly built and nourished.

No pallor ,no cyanosis, no icterus, no lymphadenopathy. 

B/l pedal edema has decreased .

VITALS:. 

Temperature: afebrile.

Pulse rate: 88 beats / min. 

Respiratory rate: 21cycles / min.

Bp: 150/100. 

Spo2: 99 

GRBS-130Mg/dl.

SYSTEMIC EXAMINATION:

Cvs: S1& S2 heard.

RESPIRATORY SYSTEM : BAE +, Position of trachea- central, no adventious sounds heard

CNS: patient is normal and concious .reflexs are normal.

Clinical findings:

Investigations.

 

 BGT : B POSITIVE

 Sr IRON: 71 ug/dl

 Sr creatinine: 9.3 mg/dl

 Blood urea: 71 mg/dl

 

USG :

ECG: 

PROVISIONAL DIAGNOSIS: Chronic renal failure

TREATMENT:

1. Fluid restriction (<1l/day)

2. Salt restriction (<2g/day)

3. T· LASIX 40 mg PO BD

4. T. Nicardia 10mg PO BD

5. T. NODOSIS 500 MG PO BD

6. T. OROFER-XT PO BD

7. T. Shelcall XT 1TAB PO OD

8. Inj.ERYTHROMYCIN 4000IU /sc weekly once

9. Inj. IRON SUCROSE 100 MG IN 100 ML NS DURING DIALYSIS

CBBLE UDHC similar cases

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 box 

A 50 year old male patient is on maintainance haemodialysis since 10 months.

HOPI: patient was apparently asymptomatic 4yrs back and then developed shortness of breath (on and off), pedal oedema (pitting type).Later diagnosed as chronic renal failure and underwent dialysis twice weekly for about 10 months.

6 years back he met with an accident. His right leg got fractured and it took nearly 1 year to heal for which he used few medication continuously for 1 year.

PAST HISTORY:

 k/c/o HTN since 1 year.

Not a K/C/O of DM, thyroid disorders, TB

PERSONAL HISTORY:

He follows a mixed diet. Appetite -Normal, Bladder movements-normal,

Bowel movements-constipation since few weeks. Sleep- decreased.consumes alcohol regularly(90ml ) and stoped consuming1 year back.

He is a farmer and stopped working since 1 year.

FAMILY HISTORY: No significant family history.

DRUG HISTORY: No known drug allegies and patient uses Nicardia 10 mg.

GENERAL EXAMINATION : 

Patient is conscious ,coherrent, co operative and well oriented to his surroundings.he is poorly built and nourished.

no pallor ,no cyanosis, no icterus, no lymphadenopathy. bilateral pedal edema is seen and is of pitting type 

VITALS: 

Temperature: afebrile

Pulse rate: 98 bpm

 Respiratory rate: 19 cpm

 Bp: 190/100.Spo2: 99 

SYSTEMIC EXAMINATION: 

CVS: bilaterally symmetric chest wall .no precordial bulge .no thrills and no murmurs.

S1& S2 heard.

RESPIRATORY SYSTEM: no dyspnoea, no wheeze

Position of trachea- central, no adventitious sounds heard

CNS: patient is normal and conscious .reflex are normal.

CLINICAL IMAGES:

Investigations: 

RFT: urea-157.  Cr.10.2.   UA-9.8

USG- Rt Grade 3 RPD

          Lt  grade 2 RPD

2D ECHO:- trivial TR+ /AR+, no MR.

Good LV systolic function.

Diastolic dysfunction (+)

ECG:

LFT: 

T.b-0.9.  D.B- 0.2.  SGOT-17.    SGPT-15.    ALKP- 504.   TP-5.6.   ALB-3.6.   A/G RATIO-1.80

RFT: U-178.  CR-10.2.  U A-9.0. CALCIUM-9.4. P-4.5.  Na-140.   K-4.7.   Cl-102

S.iron 78

RBS- 70

CUE: ALB++.   SUGARS-TRACE.  RBC's, CRYSTALS, CASTS-NIL

HAEMOGRAM

HB-5.8.   TLC-7400.   LYMPHOCYTES -13

PCV-17.4.   RBC COUNT-2.01.  PLT-1.20.    

NORMOCYTIC NORMOCHROMIC ANEMIA WITH THROMBOCYTOPENIA.

PROVISIONAL DIAGNOSIS:

NSAID ASSOCIATED RENAL IMPAIRMENT.

TREATMENT: 

1) TAB.LASIX 40MG PO/BD

2) TAB.NICARDIA 10 MG PO/BD

3)TAB.NODOSIS 500MG PO/BD

4)TAB.OROFER -XT PO/OD

5)TAB.SHELCAL-CT PO/OD

6)INJ.ERYTHROPIEOTIN 4000IU S/C ONCE WEEKLY

7) SALT AND FLUID RESTRICTION.

CBBLE UDHC similar cases

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 box

A 70 year old female home maker since 10-15 years (farmer by occupation) came to causality in drowsy state.

HOPI: Patient was apparently asymptomatic 10 years back ,then patient had h/o fall for which she went to local hospital there she got diagnosed with DM and since then she is on OHA medication(glim m2).4 years back she had h/o fall and went to hospital and got diagnosed with HTN. 1 session of dialysis was done (indication/cause unknown ) .Patient wasn’t on any medication for HTN .1 month back she developed hypoglycaemia secondary to OHA’s ,then resolved later.Patient had h/o fall 4 days back ,fracture of IT femur right leg operated(? ORIF done).On POD 2, patient was drowsy ,opening eyes to deep pain .Since yesterday ,she is unable to recognise patient attenders.

PAST HISTORY: 

K/C/O  DM since 10 years & on medication.

K/C/O HTN since 4 years

GENERAL EXAMINATION: 

O/E : Patient is responding to vocal commands

Pallor - present

Icterus  absent

Cyanosis - absent

Edema of feet - present

Lymphadenopathy  - absent

Clubbing - absent

VITALS:- 

 BP: 170/90mmhg

 PR: 98 bpm 

 RR: 25cpm 

 Spo2: 95%

 Grbs: 146

SYSTEMIC EXAMINATION : 

CARDIOVASCULAR SYSTEM : S1 and S2 heard, no murmurs heard 

RESPIRATORY SYSTEM : BAE present

P/A : soft 

CNS: Pt is drowsy.

tone : normal

INVESTIGATION:

12/2/22

D dimer: 6910ng/ml

BGT: B POSITIVE

ESR :. 140

RBS: 220

APTT: 30 seconds

PT : 15 seconds

INR: 1.11

USG abdomen 

ECG 

CT BRAIN 

VENOUS DOPPLER OF RIGHT LOWER LIMB

LFT 

PROVISIONAL DIAGNOSIS:

? uraemic encephalopathy with pre renal AKI with POD 4 right femur fracture ?CRIF + PFM with DM and HTN

TREATMENT:

1. INJ. Lasix 40mg IV/BD

2. INJ. HAI SC/TID 

3. INJ. CEFTRIAXON 1g/IV/BD

4. INJ. CLINDAMYCIN 600mg/ IV /TID

5.INJ. CLEXANE 20 mg SC/OD

6. INJ. OPTINEURON 1 AMP in 100 ml NS /IV/OD

7.TAB. Amlong 10mg PO /OD

8.IVF NS UO + 30 ml/hr

SOAP NOTES:-

DAY 2: 

S:- Patient opening eyes spontaneously

1 session of dialysis done yesterday on 13/2/22.

O:- 

TEMP:- AFEBRILE

PR:- 104bpm

BP:- 140/ 80mmhg

GRBS: 123MG/DL

CVS:- S1S2 heard , no murmurs

RS : BAE present

P/A:- SOFT , NON TENDER

I/O: 2600/1540

A:- Uremic encephalopathy ?pre renal AKI secondary to ?blood loss ? drug induced with POD 5 right femur ? CRIF + PFN with DM &HTN 

P:-

INJ. MONOCEF 1GM/IV/BD

INJ. LASIX 40 MG IV/BD

INJ. HAI SC/TID 

INJ. CLINDAMYCIN 600mg/ IV /TID

INJ. CLEXANE 20 mg SC/OD

TAB. Amlong 10mg PO /OD

IVF NS UO+ 30ML/HR

Day 3:

S:- c/o fever spike

c/o 2-3 episodes of bilious vomitings .

1 session of dialysis done yesterday on 14/2/22

O:- 

TEMP:- 101 F 

PR:- 92bpm

BP:- 140/ 60mmhg

GRBS: 123MG/DL

CVS:- S1S2 heard , no murmurs

RS : BAE present

P/A:- GUARDING PRESENT

I/O: 2400/2600

Stools : not passed

A:- Uremic encephalopathy ?pre renal AKI secondary to ?blood loss ? drug induced with POD 6 right IT femur ? CRIF + PFN with DM &HTN 

P:-

INJ. MONOCEF 1GM/IV/BD

INJ. LASIX 40 MG IV/BD

INJ. HAI SC/TID 

INJ. CLINDAMYCIN 600mg/ IV /TID

INJ. CLEXANE 20 mg SC/OD

TAB. Amlong 10mg PO /OD

IVF NS UO+ 30ML/HR

INJ ERYTHROPOIETIN 4000 IU/SC/WEEKLY ONCE.

Day 4:

S:- c/o fever spike yesterday 

O:- 

TEMP:- 98.4 F 

PR:- 96 bpm

BP:- 150/ 90mmhg

GRBS: 245MG/DL

CVS:- S1S2 heard , no murmurs

RS : BAE present

P/A:- GUARDING PRESENT

I/O: 2100/3200

Stools : passed 

A:-  Uremic encephalopathy ?pre renal AKI secondary to ?blood loss ? drug induced ?dehydration with POD 7 right IT femur ? CRIF + PFN with DM &HTN 

Surgery referral done i/v/o abdominal distension and vomiting, DIAGNOSIS: ? ADYNAMIC INTESTIONAL OBSTRUCTION, suggested CT ABDOMEN . 

P:- SOAP WATER  ENEMA DONE 

(DAY 1)INJ. PIPTAZ 4.5 GM/IV/STAT

                        | 

          PIPTAZ 2.25 GM/IV/BD 

INJ. LASIX 40 MG IV/BD

INJ. HAI SC/TID 

INJ. CLINDAMYCIN 600mg/ IV /TID

INJ. CLEXANE 20 mg SC/OD

TAB. Amlong 10mg PO /OD

IVF NS UO + 30ML / HR 

INJ ERYTHROPOIETIN 4000 IU/SC/WEEKLY ONCE.

Day 5:

S:- c/o abdominal pain and right femur pain.responding to commands. 1 session of dialysis yesterday on 16/2/22 and ortho dressing has been done 

O:- 

TEMP:- 100.4F 

PR:- 94bpm

BP:- 180/100mmhg

GRBS: 123MG/DL

CVS:- S1S2 heard , no murmurs

RS : BAE present

P/A:- GUARDING PRESENT

I/O: 2400/3000

Stools :  passed,enema given 

A:-  Uremic encephalopathy (resolving) pre renal AKI secondary to ?blood loss ? drug induced with POD 8 right IT femur ? CRIF + PFN with DM &HTN 

P:- 

(DAY 2)INJ. PIPTAZ 4.5 GM/IV/STAT

                        | 

          PIPTAZ 2.25 GM/IV/BD 

INJ. LASIX 40 MG IV/BD

INJ. HAI SC/TID 

INJ. CLINDAMYCIN 600mg/ IV /TID

INJ. CLEXANE 20 mg SC/OD

TAB. Amlong 10mg PO /OD

IVF NS UO + 30ML / HR 

INJ ERYTHROPOIETIN 4000 IU/SC/WEEKLY ONCE.

Day 6:

S:- c/o abdominal pain and right femur pain.responding to commands 

O:- 

TEMP:- 98.4F 

PR:- 90bpm

BP:- 140/100mmhg

GRBS: 223MG/DL @ 8am 

CVS:- S1S2 heard , no murmurs

RS : BAE present

P/A:- GUARDING PRESENT

I/O: 1700/2100

Stools :  passed 

A:-  Uremic encephalopathy (resolving) pre renal AKI secondary to ?blood loss ? drug induced with POD 9 right IT femur ? CRIF + PFN with DM &HTN 

P:- 

(DAY 3) PIPTAZ 2.25 GM/IV/QID

INJ. LASIX 40 MG IV/BD

INJ. HAI SC/TID 

(Day7)INJ. CLINDAMYCIN 600mg/ IV /TID

(Day7)INJ. CLEXANE 20 mg SC/OD

TAB. Amlong 10mg PO /OD

IVF NS UO + 30ML / HR 

INJ ERYTHROPOIETIN 4000 IU/SC/WEEKLY ONCE.

 DAY 7:

 S:-  c/o pain in gluteal region since yesterday ,abdominal pain decreased and right femur pain decreased.responding to commands.

O:- 

TEMP:- 98.4F 

PR:- 90bpm

BP:- 130/90 mm hg

GRBS: 212MG/DL @ 8am 

CVS:- S1S2 heard , no murmurs

RS : BAE present

P/A:- soft 

I/O: 1650/2200

Stools :  passed 

Grade 1 bed sore at gluteal region 

A:-  Uremic encephalopathy (resolving) pre renal AKI secondary to ?blood loss ? drug induced with POD 10 right IT femur ? CRIF + PFN with DM &HTN 

P:- 

(DAY 4) PIPTAZ 2.25 GM/IV/QID

INJ. LASIX 40 MG IV/BD

INJ. HAI SC/TID 

(Day8)INJ. CLINDAMYCIN 600mg/ IV /TID

(Day8)INJ. CLEXANE 20 mg SC/OD

TAB. Amlong 10mg PO /OD

IVF NS UO + 30ML / HR 

INJ ERYTHROPOIETIN 4000 IU/SC/WEEKLY ONCE.

          Grade 1 bed sore at gluteal region