A 42yr/F came to the casualty with complaints of fever , nausea , constipation , generalised weakness since 7days ; burning micturition since 1day.

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A 42 y /F came to the casualty with complaints of fever , nausea , constipation , generalised weakness since 7days ; burning micturition since 1day 

HOPI- 
Patient was apparently asymptomatic 1week back , intermittent not associated with chills , rigors , associated with generalised weakness . Patient not able to get up from bed associated with nausea , constipation , passing flatus .
No c/o loose stools and vomitings.
C/o burning micturition since 1day .
Dry cough since 1day 
No c/o sputum , SOB , bleeding manifestations.

Past history-
Not a k/c/o DM , HTN ,TB, Asthma ,CAD .

Personal history -
Diet - veg
Appetite - Decreased 
Sleep - Adequate 
Bowel & bladder movements - regular 
Rashes and itching on eating non veg .
No addictions .

Family history - not significant.

On Examination -
Patient is c/c/c 
Temp - 99°F
BP -120/80 mmHg
PR - 89bpm
RR -18cpm 
GRBS - 112mg%
CVS - S1 S2 +ve 
RS - BAE +ve 
P/A - soft, NT,BAE +ve 

Provisional diagnosis -Fever under evaluation 

Investigations-
Treatment -
IVF -NS,RL,DNS @75ML)HR
INJ PANTOP 40MG IV OD
INJ ZOFER 4MG IV SOS 
INJ OPTINEURON 1AMP IN 100ML NS IV OD 
INJ NEOMOL 1GM IV SOS (IF TEMP >101°F)
TAB DOLO 650 MG PO SOS
SYP LACTULOSE 10ML PO H/S 

SOAP NOTES
Day 1 

S- one fever spike+ yesterday ,   decreased appetite , giddiness + , neck pains + , c/o burning micturition .


O-
Patient is c/c/c
Temp - 99°F
BP -110/90 mmHg
PR - 93bpm
RR -21cpm
GRBS - 112mg%
SpO2 -98%@RA
CVS - S1 S2 +ve
RS - BAE +ve
P/A - soft, NT,BAE +ve

A-
Fever under evaluation , ?UTI

IVF -NS,RL,DNS @75ML)HR
INJ OPTINEURON 1AMP IN 100ML NS IV OD 
INJ NEOMOL 1GM IV SOS (IF TEMP >101°F)
INJ PANTOP 40MG IV OD
INJ ZOFER 4MG IV SOS 
TAB DOLO 650 MG PO SOS
SYP LACTULOSE 15ml PO/BD

Day 2 

S-  decreased appetite , giddiness + , neck pains + , no fever spikes yesterday , decreased burning micturition .


O-
Patient is c/c/c
Temp - 99°F
BP -130/90 mmHg
PR - 88bpm
RR -20cpm
GRBS - 132mg%
SpO2 -98%@RA
I/O - 2000/1100
CVS - S1 S2 +ve
RS - BAE +ve
P/A - soft, NT,BAE +ve

A-
Fever under evaluation , ?UTI

P-
INJ OPTINEURON 1AMP IN 100ML NS IV OD
INJ NEOMOL 1GM IV SOS (IF TEMP >101°F)
TAB PANTOP 40MG IV OD
TAB ZOFER 4MG IV SOS
TAB DOLO 650 MG PO SOS
SYP LACTULOSE 10ML PO H/S

PLENTY OF ORAL FLUIDS 


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