Fever Nausea Abdominal pain
Female patient of age 22 comes in opd with complain of fever and nausea Abdomen pain right lumber and epigastric region. Chief Complaints Fever Pain since two days Mild cough dry History History Vitals Bp:120/70 Temprature:103 Pulse: 150 Spo2:96 Physical Examination Weak Anemic Bilateral chest clear No throat congestion No chest pain No breathing Problem Investigations Cbc: hb:11 Platelets: 2.2 Esr: 38 Lft normal Kft: BUN: 20.8 Urine rm normal Widal 1/80 ++ 1/320+ Usg: Mild tenderness over right lumber (Cect abdomen adviced to confirm) Diagnosis Enteric fever??? Covid?? Management In ipd treatment dated 02/10/2020 Inj: pcm iv Inj:pantop Inj:emeset When temprature goes down to 99 Injection monocef sb iv stat in 100ml ns Todays: 8am fever again rise to 102 f Tab: Dolo 650 mg oral stat given + injection monocef sb iv stat Now what should be next step???? Need to be discuss.
From history it is widal positive I will suggest get cross widal test for confirmation Yes treat as enteric fever Inj Ceftriaxozone Inj ofloxacin Inj ondestron Inj pantaprazole Inj paracetamol in slow drip As esr is high do advise for crp and RT pcr xray chest Sr electrolytes Maintain hydration
Widal positive Means Typhoid fever Start with Ceftriaxone 1gm bd Ofloxacin 100ml bd Antipyretics like Dolo 650 tds For abdomen Do USG Soft diet and plenty of liquids Multivitamin and antioxidants
At present diagnosis is Typhoid Ceftriaxone 1 gm iv 12 hrly Paracetamol 500 mg qid Azithromycin 250 bid Multivitamins Go for USG whole abdomen
Enteric fever Suggest to continue Ceftriaxone 2 gm IV in 100 ml NS Suggest Abdominal ultrasound to rule out associated gall bladder problems.
Enteric fever Inj ceftriaxone 2 g iv bd Antiemetics and anti pyretics iv
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