patient 30 yrs, female. Widal test positive, RBC low, Blood sugar Random after consuming much sweet is 100. patient has a history of reoccurring typhoid after an interval of 2-3 yrs. at present patient complaining mild fever, vertigo, body ache, sometimes constipation and excess fatigue and weakness.just after consuming sweets like mishry(local sugar) she feels well for 3,4 hrs. stool,urine normal, no other complaints. patient is having it for 3days and taking allopathic treatment at present.like cefixime+ofoxacin antibiotics, antipyretic and haematinic.has been taking allopathic treatment for 2days.only got relief in vertigo after treatment. please suggest Dx and Rx.

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If stool c/s is normal, Salmonella is very unlikely. Widal comes positive after 1st week in typhoid. This denotes some previous infection. If there is a doubt, you can advise blood c/s and IgG and IgM to determine a previous or current infection of Widal. Oral Iron supplementation should be not be given during fevers ( but post infection only). It may be causing constipation ( only through IV when it is required in a few cases). And according to theories, it may nourish a few pathogens during infection. In a few patients, ofloxacin may cause hypoglycemia, it should be reviewed. The patient must take a typhoid vaccine after 1 month when her symptoms are relieved.

Thank you madam for suggestions.
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She is receiving appropriate treatment for Typhoid. The giddiness may be associated with general hleath of the pt, BP, HR, Thyroid Harmones. But HB is normal so its not realted with Anaemia. Kindly check her BP , start with Tab Cinarzine 10 mg once in morning for 15 days along with ongoing medicines. And Adjust dose as per improvement. Now, as per history if pt having previous history of Hypoglycemia or if she had recurrent giddiness and feels better after consumption of sugar, then must think about other pathology too especially possible pancreatic pathology. Kindly do USG abdomen + pelvis, and Blood sugar Fasting . For more accurate diagnosis.

Thank you sir for valuable suggestions.
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Mahasudershan Ghana vati Sanjeewani vati Giloy Ghana vati Sarva jwarhara lauh. Guduchyadi lauh Mukta pishti Sitopaladi choorna. Amritarista + Rohitakarista. Khameera Marwarid.

Thank you sir for suggestion.
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Go for pancreatic investigation.....is pt taking any OCP.

No OCP. thank you sir for suggestion but about typhoid what is your view. please suggest.
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Go for hormonal status

Ok. thank you sir.
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If typhoid not treated well,the next step turns to T.B. also.typhoid effects the whole body glands & can respected again &again. Needs care full tt. Sawran bnt milti ras+godenti bsm+ Satv giloy+mukta Shukti bsm+sito Pladi with honey bid. Amertarisht with Sudarshan vati or Shashamni vati after meal. Temp may be reduced like pachan After 10 days Sanjivani vati after meal.Milk,curd any juice may avoid till normal temp.Fried Munnekka at night. After recovery Taiyari loh &Amerita risht can provide as reqd.Bath may avoid till normal temp.Hot water cloth bath can Follow.Any alration of med.accrd To dosh.

Thank you so much sir for suggestions.
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@Dr. S. F. Ahmed Sir If the history of hypoglycemia is sudden, I suspect it's Meningitis. If it's an old history of hypoglycemia, low HB and RBC count, renal disease/ adrenal fatigue are suspected first of all. Other mimics to be ruled out, if these reports are ok, aplastic anemia, poor liver function, thyroid disorder, tumors of adrenal and pituitary gland.

No never felt such problem.
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Agree with @Dr. Divya Sharma ma'am Ofloxacin may leads to hypoglycemia in some cases.... Rule out the origin of Typhoid agent, Advice to prefer safe drinking water... If patient is on allopathic management then continue the same don't mix two pathy.... Good Luck @Dr. S. F. Ahmed sir

Thank you sir.previously i gave this patient mahasudarshan ghan vati and giloy vati.she got complete relief.but after a long period reoccurred the problem.symptoms were strange so i suggest her to take allopathic for some time to control the symptoms.
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As there is history of recurrence of typhoid Ask patient to be on strict diet. Should avoid all spice n oily foods Better to take rice n dhal or dalia, apple n pomegranate juice, no milk products Amritharishta 10ml 4hrs once Chandanasav 10ml bd Punarnavadi mandoora n mahasudarshana vati each 1 tab twice daily

Thank you madam for suggestions
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रोगी आन्त्रिक ज्वर से पीड़ित है। चिकित्सा संबंधी योग,,, जयमंगल रस स्वर्ण युक्त 1 रत्ती सत गिलोय 4 रत्ती भर गोदन्ती भस्म 4 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं निश्चित रूप से लाभ होगा योग परिक्षित है पिछले 40 वर्ष से प्रयोग कर रहा हूं

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