A 45 yr old male
A patient who is 45 yr old male came to OPD with chief complaints of fever since 2 days and slurring of speech since 1 day and pain in both lowerlimbs .
HISTORY OF PRESENT ILLNESS
Patient is a daily wage worker by occupation . Patient was apparently asymptomatic 2 years back then his appetite increased( about 5- 6 times a day ) for which he came to KIMS hospital and diagnosed with Diabetes.He used oral hypoglycemic drugs for first 6 months.Then from past 1.5 years he is on insulin.He was a chronic alcoholic since 25 yrs. He consumes more than 180ml / day . Urine output increased since 2 years about 10 times a day.Decreased weight about 25kg since 2 years.
Then since 2 days he developed fever which was high grade, continuous and associated with chills and rigor and also presence of neck stiffness and burning Micturition.Patient was also anemic for which he received blood transfusion
He developed slurring of speech since 1 day then he came to hospital the next day
HISTORY OF PAST ILLNESS
Patient is a
K/c/o DM
Not a k/c/o asthma , hypertension , CAD
FAMILY HISTORY - not significant
Bowel and bladder movements - normal
Micturition - buring
Appetite - increased
Sleep - normal
Diet - normal
GENERAL EXAMINATION tte
Pallor - yes
Clubbing - no
Cyanosis - no
Lymphadenopathy - no
Icterus - no
VITALS
Bp- 110/80 mmhg
Respiratory rate - 20/ min
Pulse rate - 100/min
Temperature - 97
SPO2 - 98%
SYSTEMIC EXAMINATION
CVS
No thrills and no murmurs
Cardiac sounds S1 S2 heard
RESPIRATORY SYSTEM
Trachea - central
Wheezing - no
Dysnea - no
Breath sounds - vesicular
CNS
Level of consciousness - conscious
Speech - slurred
Signs of meningeal infection
Neck stiffness - yes
Kernings - postive
PROVISIONAL DIAGNOSIS
Viral meningitis
With k/c/o DM since 2 yrs
Investigations
28-7-22
Ultra sound
31-7-221-8-22
TREATMENT
Iv fluids NS/RL/DNS 75ml/hr
Inj..Meropenem 500 mg /Iv/BD
Inj.Neomol 1gm/iv/sos of temperature is 102 or more
Inj.HAI SK acc to GRBS
Inj. Thiamine 200 mg /IV/BD
Inj.Vit K 10 mg SC OD
Tab.Dolo 650 mg
Tab. Doxy 100 mg /PO
Inj.PAN 40mg /IV/ OD
Protein X powder 1 scoop + 100 ml milk 4th hrly
GRBS profile
BP/PR/Temp/SPO2 4th hrly
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