50year old women with fever and thrombocytopenia
21 August 2022
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Phani Keerthana
Roll no 72
A 58 yr old woman farmer by occupation resident of nakrekal presented to op with chief complaints of fever and swelling on both legs
History of presenting illness-
Patient was apparently asymptomatic 5 days back. Then she developed fever which was insidious in onset intermittent in nature and relieved on medication(dolo) and increases during night time around 4 AM. 5 days before the onset of fever she was travelling to nearby villages in rains and had decreased appetite and has also been working on her farms.
There is history of swelling in the foot which was gradual and associated with onset of fever and has decreased since 2 days.
There is a history of loose stools 5 days back with 4 episodes which was because of intake of Vamu ( Ajwain) , ( which she normally takes due to her constipation i.e., she has bowel movements once every 3 days and every time before she had normal motions but this time it was diarrhea) and associated with pain for half an hour in lower abdomem after her present bowel movement ? Pain.
She has history of association pain in the lower limbs from waist to toe which is dragging type and present everytime she moves her legs since 5 days.
She has an history of vomiting 2 days back of 3 episodes everytime she consumes food which was associated with nausea and had food as it contents.
She visited the local hospital 4 days back where she had some test done which reported to have low platelets count and she was referred to our hospital for further care and investigation.
PAST HISTORY:
She is not an known case of Diabetes Hypertension Asthma Lerposy and Epilepsy
She has a surgical history of hysterectomy done 20 yes back.
FAMILY HISTORY:
Not significant
PERSONAL HISTORY:
Diet - Mixed
Appetite - Decreased since long time and further reduced since last 5 days
Bowel and bladder - Constipation since 2 yrs and diarrhea 5 days back.
Sleep - Adequate
Drugs - Toddy occasionally on festives.
Allergies - none.
24 HR RECALL:
1 idli yesterday evening
And rice after some time
And 1 idli in the morning today.
GENRAL EXAMINATION:
Patient is conscious coherent and co operative well oriented to time place and person.
Patient was examined in a well lit room and consent was taken.
Vital -
PR-75bpm
BP-110/70
RR-16cpm
SPo2-98%
Temp-Afebrile
Pallor - Absent
Icterus - present
Clubbing - Absent
Cyanosis- Absent
Lymphadenooathy- Absent
Edema - B/l pedal edema
SYSTEMIC EXAMINATION-
CVS-
S1, S2 heard
Resp
NVBS
CNS-
NFD
PER ABDOMEN-
Soft and non tender
INVESTIGATION-
NS1 , Ig G, Ig M :- Negative
fever chart-

Blood urea levels -
On 21/08 - 144mg/dl (12-42)
On 22/08 - 123mg/dl
Creatinine levels-
On 21/08 - 3.8mg/dl (0.6-1.1)
LFT-
PROVISIONAL DIAGNOSIS-
AKI
PLAN OF TREATMENT-
1.IVF - ns, RL @75ml/hr
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