64 old year male with fever

A 64 year old male with chief complaints of fever since 4 days, loose stools since 4 days , swelling of the left lower limb since a month and abdominal distension since one month 

• Fever since 4 days.  High grade a/w chills, decreases on medication.  
• Loose stools since 4 days a/w mucoid, small volume, watery consistency 
• Swelling of the left lower Limb since past one month 
• Abdominal distension since past one month  
• No h/o pain abdomen 
• No h/o blood and pus in stools.  

PAST HISTORY: 

K/c/o bronchial asthma  using Inhalers 2-3 times per day since 5 years

And uses nebulisers since 2 years

PERSONAL HISTORY: 

Appetite - normal 

Diet- mixed

Bowels- regular. 

Micturition- abnormal 

Known allergies - none 

FAMILY HISTORY : 

Nothing significant.  

PHYSICAL EXAMINATION: 

GENERAL : 

No signs of pallor, icterus, clubbing,koilonychia, lymphadenopathy or malnutrition.  

Dehydration - yes 

Oedema of feet - yes 

VITALS: 

Temp- a febrile

Pulse rate - 90/min 

Respiration rate-26/min 

Bp- 80/60 mm of hg

Spo2: 98% at 4L of o2 

SYSTEMIC EXAMINATION: 

CVS: S1S2 ++ 

RESPIRATORY SYSTEM: 

• Dyspnoea - yes 
• Position of trachea - central 
• Breath sounds - vesicular 

PER ABDOMEN : 

• Shape of abdomen - scaphoid 
• Tenderness - not 
• Palpable mass- no 
• Hernial orifices - normal 
• Free fluid - no 
• Bruits- no 
• Liver- not palpable 
• Spleen - not palpable. 
• Bowel sounds - yes. 

CNS: 

Level of consciousness- conscious 

Speech- normal 

Signs of meningeal irritation- none 

INVESTIGATIONS: 

1.anti HCV antibodies - RAPID 

2. ABG 

3. HIV 1/2 rapid test :

4. SARS COV -2 PCR 

5. ECG

6. ULTRASOUND REPORT: 

7. HBsAg-RAPID 

PROVISIONAL DIAGNOSIS: 

Acute gastroenteritis 

With k/c/o bronchial Asthma 

With de novo detected diabetes 

With left lower limb cellulitis 

?septic shock 

TREATMENT: 

DAY 1: 

• IVF- NS and RL = 1000ml/hr 
• Inj. Hydrocort 100mg iv
• CPAP ventilation 
• Neb with budecort , 4th hourly 
• Inj. HAI s/c acc to GRBS 
• Tab sporlac DS po/TID 
• Strict I/o monitoring 
• Inj piptaz 4.5 gn IV/ stat 
• Inj clindamycin 600mg IV/BD

DAY 2 : 

• Inj streptokinase, 3 ml/hr 
• Fluid restriction <1.5 l/ day 
• Salt restriction <4gm/day 
• Inj piptaz 2.25 gm /IV/ TID 
• Inj clindamycin 600mg /IV/TID 
• Inj. Hydrocortisone 100mg/IV/TID 
• Inj. Neb with budecort 6th hourly 
• Intermittent CPAP ventilation 
• Strict I/o monitoring 
• BP, PR, SPO2 monitoring hourly 
• Inj. Heparin 1ml (1000IU) in 4 ml NS/IV/QID