46 year old male with c/o left lower limb swelling
46yr old male with complains of left lower limb swelling
This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent
Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs
This E log also reflects my patient centre’s online learning portfolio and valuable inputs on the comment box is welcome.
This is a case of 46yr old male who is shopkeeper by occupation presented with complaint of swelling of left lower limb since 15days
Patient was apparent asymptomatic15 days back then he had consulted a physician outside for the B/L pedal edema and 5 days back in an intoxicated state patient fell down from the bike, when he suffered an injury to his left leg and had swelling of that limb for which he received treatment from outside hospital for 3days but as the wound was not healing, he was referred to our hospital.
There was h/o fever 3days back which was low grade and continuous fever and was not associated with chills and rigors and was relieved on medication.
He also had h/o constipation for 3days followed by passage of loose stools 2 -3 episodes non foul smelling and no blood tinge.
Past history:
h/o seizures 15 years back since then he is on medication.
k/ c/o diabetes since 5 months and he is on regular medication
not k/c/o hypertension, CAD, asthma, tuberculosis
SURGERIES:
h/o head injury 15yrs back when patient was diagnosed with intracranial bleed and was taken for surgery.
PERSONAL HISTORY:
He takes vegetarian diet, with normal appetite and regular Bowel and bladder habits
He started smoking 15years back and smokes 3 packs per day and he is a alcoholic since 15years
No known allergies
Family history: No significant family history
GENARAL EXAMINATION
Patient was conscious, coherent, cooperative
Patient looks obese
He has bilateral pedal edema
No Pallor, Icterus, Clubbing, Cyanosis, Lymphadenopathy
There were no signs of dehydration
VITALS:
Temperature: afebrile
SPO2: 90% at room air
Pulse rate: 94 bpm
Respiratory rate: 18/min
BP: 160/100 mmHg
SYSTEMIC EXAMINATION
CVS
- S1 and S2 heard
- No murmurs
Respiratory System
- Trachea is in central position
- Bilateral air entry present
- Normal Vesicular breath sounds heard
Per Abdomen
- Obese abdomen
- No tenderness
- No palpable mass,
- No organomegaly
- Bowel sounds are heard
CNS
- Conscious and normal speech
- Normal gait
- Cranial nerves normal
- Sensory system normal
- Motor system normal
- No signs of meningeal irritation.
Fever charting:
Hb- 10.4
TLC - 18000
Neutro - 78
Esino - 2
Baso - 0
Lympho - 10
Mono - 10
PROVISIONAL DIAGNOSIS :
Left lower limb cellulitis with sepsis with k/c/o DM type 2 since 5 months with COPD with OSA with hypokalemia with mild ARDS
TREATMENT:
• On day 0
- O2 inhalation @ 4-6 47/min
- INJ. MEROPENEM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDECORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (DIABEAC PROTIEN POWDER )
Patient was referred to psychiatrist i/v/o h/o chronic smoking and chronic alcoholism, for which psychiatrist has added
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 3
- O2 inhalation @ 4-6 47/min
- Inj. meropenem 1g/iv/BD
- inj. clindamycin 600 mg /iv
- Inj. pan 40 mg /od
- inj. zofer 4 mg /iv/tid
- inj HAI s/c acc to GRBS
- neb. duolin 5th hrly and budeeort 12th hrly
- inj levipil 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (D1ABEAC PROTIEN POWDER )
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 4
INJ MEROPENEM
INJ CLINDAMYCIN 600MG / IV/TID
INJ PAN 40 MG /1V/TID
INJ ZOFER 4MG /4MG /1V /BD
INJ HAI S/C ACC TO GRBS
INJ LEVIPIL 900 MG /1V/BD
INJ CLEXANE 40 MG /SC /OD
TAB. PREGABALINE
TAB. BENXL
NICOTINEX CHEWING GUMS
Day 5
- O2 inhalation @ 4-6 47/min
- INJ. MEROPENAM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDEEORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (DIABEAC PROTIEN POWDER )
Patient was referred to psychiatrist i/v/o h/o chronic smoking and chronic alcoholism, for which psychiatrist has added
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 3
- O2 inhalation @ 4-6 47/min
- Inj. meropenam 1g/iv/BD
- inj. clindamycin 600 mg /iv
- Inj. pan 40 mg /od
- inj. zofer 4 mg /iv/tid
- inj HAI s/c acc to GRBS
- neb. duolin 5th hrly and budeeort 12th hrly
- inj levipil 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (D1ABEAC PROTIEN POWDER )
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 4
INJ MEROPENEM
INJ CLINDAMYCIN 600MG / IV/TID
INJ PAN 40 MG /1V/TID
INJ ZOFER 4MG /4MG /1V /BD
INJ HAI S/C ACC TO GRBS
INJ LEVIPIL 900 MG /1V/BD
INJ CLEXANE 40 MG /SC /OD
TAB. PREGABALINE
TAB. BENXL
NICOTINEX CHEWING GUMS
Day 5
CUE - Normal
Blood grouping and typing - A positive
Bleeding time - 2mins
Clotting time - 5mins
Serology for HIV, HCV and HbsAg - negative
SARS COVID 19 - negative
LFT
TB - 2.8
DB -1.02
AST - 18
ALT - 12
ALP - 190
TP - 5
Albumin - 2
RFT
Urea - 24
Creat - 0.9
Sr. Na - 133
Sr. K - 3.2
Sr. Cl - 94
Chest X ray
ECG
2D echo
Blood culture
Urine culture
Culture and sensitivity of swab from the wound
Urinary proteins
PROVISIONAL DIAGNOSIS :
Left lower limb cellulitis with sepsis with k/c/o DM type 2 since 5 months with COPD with OSA with hypokalemia with mild ARDS
TREATMENT:
• On day 0
VITALS
Temperature - 98F
BP - 140/790 mmHg
PR - 94 bpm
SpO2 - 85% at RA
GRBS - 121mg/dl
Treatment given
- Proped up posture
- O2 inhalation @ 4-6 47/min
- Inj. MEROPENEM 1g/iv/BD
- inj. CLINDAMYCIN 600 mg /iv
- Inj. PAN 40 mg /od
- Inj. ZOFER 4 mg /iv/tid
- Inj HAI s/c acc to GRBS
- Neb. DUOLIN 5th hrly and BUDECORT 12th hrly
- Inj LEVIPIL 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER )
- Syp. POTCHLOR 10 ml 1 Glass of WATER /PO/BD
Day 1
- O2 inhalation @ 4-6 47/min
- Inj. MEROPENEM 1g/iv/BD
- inj. CLINDAMYCIN 600 mg /iv
- Inj. PAN 40 mg /od
- Inj. ZOFER 4 mg /iv/tid
- Inj HAI s/c acc to GRBS
- Neb. DUOLIN 5th hrly and BUDECORT 12th hrly
- Inj LEVIPIL 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER )
- Syp. POTCHLOR 10 ml 1 Glass of WATER /PO/BD
Day 1
VITALS
Temperature- 98.6F
BP - 150/90 mm Hg
PR - 96bpm
SpO2 - 84% at RA and 96% at 6L of O2
GRBS - 140 mg/dl
Treatment given
- proped up posture
- O2 inhalation @ 4-6 47/min
- INJ. MEROPENEM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDECORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (D1ABEAC PROTEIN POWDER )
Day 2
- O2 inhalation @ 4-6 47/min
- INJ. MEROPENEM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDECORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (D1ABEAC PROTEIN POWDER )
Day 2
VITALS
Temperature- 99 F
BP - 140/90 mmHg
PR - 89 bpm
SpO2 - 96 at 6L of O2
GRBS - 133 mg/dl
Treatment given
- proped up posture - O2 inhalation @ 4-6 47/min
- INJ. MEROPENEM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDECORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (DIABEAC PROTIEN POWDER )
Patient was referred to psychiatrist i/v/o h/o chronic smoking and chronic alcoholism, for which psychiatrist has added
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 3
VITALS
Temperature- 99 F
BP - 140/90 mmhg
PR - 102 bpm
SpO2 -
GRBS - 125 mg/dl
Treatment given
proped up posture - O2 inhalation @ 4-6 47/min
- Inj. meropenem 1g/iv/BD
- inj. clindamycin 600 mg /iv
- Inj. pan 40 mg /od
- inj. zofer 4 mg /iv/tid
- inj HAI s/c acc to GRBS
- neb. duolin 5th hrly and budeeort 12th hrly
- inj levipil 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- protein powder in 1 glass of milk/po/bd (D1ABEAC PROTIEN POWDER )
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 4
VITALS
Temperature- 98F
BP - 130/80 mmhg
PR - 94 bpm
SpO2 - 99 % at 6L of O2
GRBS - 122 gm/dl
Treatment given
DIABETES DIET INJ MEROPENEM
INJ CLINDAMYCIN 600MG / IV/TID
INJ PAN 40 MG /1V/TID
INJ ZOFER 4MG /4MG /1V /BD
INJ HAI S/C ACC TO GRBS
INJ LEVIPIL 900 MG /1V/BD
INJ CLEXANE 40 MG /SC /OD
TAB. PREGABALINE
TAB. BENXL
NICOTINEX CHEWING GUMS
Day 5
No new complaints
VITALS
Temperature- 98.5 F
BP - 140/80 mmHg
PR - 89 bpm
SpO2 - 98 % at 6L of O2
GRBS - 130 gm/dl
Sr. K+ - 3.0
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 6
He has complaint of 3 episodes of loose stools
VITALS
Temperature- 98.5 F
BP - 130/80 mmHg
PR - 84 bpm
SpO2 - 98 % at 6L of O2
GRBS - 122 gm/dl
Sr. K+ - 3.1
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 7
C/o Loose stools subsided
VITALS
Temperature- 98 F
BP - 110/60 mmHg
PR - 100 bpm
SpO2 - 98 % at 6L of O2
GRBS - 96 gm/dl
Hb - 8.5
Treatment given
- Proped up posture
- IV Fluids 2NS and 2RL at 75ml/hr
- IV Fluids 2NS and 2RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. AMLONG 10mg PO/OD
- TAB. SPOROLAC- DS PO/BD
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 8
No new complaints
VITALS
Temperature- 100 F
BP - 150/100 mmHg
PR - 94 bpm
SpO2 - 96 % at 6L of O2
GRBS - 101 gm/dl
Hb - 8.4
Sr. Na - 133
Sr. K - 2.9
Sr. Cl - 94
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD/PO
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. PAN 40 mg /OD/PO
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 9
No new complaints
VITALS
Temperature- 98.5 F
BP - 130/80 mmHg
PR - 84 bpm
SpO2 - 98 % at 4L of O2
GRBS - 122 gm/dl
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 10
No new complaints
VITALS
Temperature- 98.5F
BP - 140/90 mmHg
PR - 85 bpm
SpO2 - 98 % at 2L of O2
GRBS - 116 gm/dl
Sr. K - 3.3
Treatment given
- Propped up posture
- IV Fluids 1NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- TAB. AUGMENTIN 625mg PO/OD
- TAB. CHYMEROL FORTE BD/PO
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 11
No new complaints
VITALS
Temperature- 98 F
BP - 130/90 mmHg
PR - 82 bpm
SpO2 - 88 % at Ra
GRBS - 117 gm/dl
Sr. Na - 134
Sr. K - 3.3
Sr. Cl - 97
Treatment given
- Propped up posture
- IV Fluids 1NS at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- TAB. CHYMEROL FORTE BD/PO
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 12
No new complaints
VITALS
Temperature- 98 F
BP - 150/90 mmHg
PR - 80 bpm
SpO2 - 88 % at Ra
GRBS - 120 gm/dl
Ur. Na - 187
Ur. K - 8
Ur. Cl - 192
Treatment given
- Propped up posture
- plenty of oral fluids
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- TAB. CHYMEROL FORTE BD/PO
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. TELMA AM 40/5mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- 3 egg white /day
Day 13
No new complaints
VITALS
Temperature- 98 F
BP - 150/100 mmHg
PR - 90 bpm
SpO2 - 94 % at Ra
GRBS - 116 gm/dl
Hb - 9
TLC - 6700
PLT - 3.45
Sr. K - 3.2
Sr. Na - 133
Treatment given
- Propped up posture
- plenty of oral fluids
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- TAB. CHYMEROL FORTE BD/PO
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. TELMA AM 40/5mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- 3 egg white /day
Day 14
No new complaints
VITALS
Temperature- 98 F
BP - 140/90 mmHg
PR - 110 bpm
SpO2 - 94 % at Ra
GRBS - 120 gm/dl
Hb - 8.6
TLC - 7400
PLT - 4.5
Sr. K - 2.8
Treatment given
- Propped up posture
- plenty of oral fluids
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDECORT 8th hrly
- TAB. CHYMEROL FORTE BD/PO
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. TELMA AM 40/5mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- 3 egg white /day
DISCHARGE SUMMARY:
Case
This is a case of 46yr old male who is shopkeeper by occupation presented with complaint of swelling of left lower limb since 15days
Patient was apparent asymptomatic15 days back then he had consulted a physician outside for the B/L pedal edema and 5 days back in an intoxicated state patient fell down from the bike, when he suffered an injury to his left leg and had swelling of that limb for which he received treatment from outside hospital for 3days but as the wound was not healing, he was referred to our hospital.
There was h/o fever 3days back which was low grade and continuous fever and was not associated with chills and rigors and was relieved on medication.
He also had h/o constipation for 3days followed by passage of loose stools 2 -3 episodes non foul smelling and no blood tinge.
Past history:
h/o seizures 15 years back since then he is on medication.
k/ c/o diabetes since 5 months and he is on regular medication
not k/c/o hypertension, CAD, asthma, tuberculosis
SURGERIES:
h/o head injury 15yrs back when patient was diagnosed with intracranial bleed and was taken for surgery.
PERSONAL HISTORY:
He takes vegetarian diet, with normal appetite and regular Bowel and bladder habits
He started smoking 15years back and smokes 3 packs per day and he is a alcoholic since 15years
No known allergies
Family history: No significant family history
GENARAL EXAMINATION
Patient was conscious, coherent, cooperative
Patient looks obese
He has bilateral pedal edema
No Pallor, Icterus, Clubbing, Cyanosis, Lymphadenopathy
There were no signs of dehydration
VITALS:
Temperature: afebrile
SPO2: 90% at room air
Pulse rate: 94 bpm
Respiratory rate: 18/min
BP: 160/100 mmHg
SYSTEMIC EXAMINATION
CVS
- S1 and S2 heard
- No murmurs
Respiratory System
- Trachea is in central position
- Bilateral air entry present
- Normal Vesicular breath sounds heard
Per Abdomen
- Obese abdomen
- No tenderness
- No palpable mass,
- No organomegaly
- Bowel sounds are heard
CNS
- Conscious and normal speech
- Normal gait
- Cranial nerves normal
- Sensory system normal
- Motor system normal
- No signs of meningeal irritation.
INVESTIGATIONS:
This is a case of 46yr old male who is shopkeeper by occupation presented with complaint of swelling of left lower limb since 15days
Patient was apparent asymptomatic15 days back then he had consulted a physician outside for the B/L pedal edema and 5 days back in an intoxicated state patient fell down from the bike, when he suffered an injury to his left leg and had swelling of that limb for which he received treatment from outside hospital for 3days but as the wound was not healing, he was referred to our hospital.
There was h/o fever 3days back which was low grade and continuous fever and was not associated with chills and rigors and was relieved on medication.
He also had h/o constipation for 3days followed by passage of loose stools 2 -3 episodes non foul smelling and no blood tinge.
Past history:
h/o seizures 15 years back since then he is on medication.
k/ c/o diabetes since 5 months and he is on regular medication
not k/c/o hypertension, CAD, asthma, tuberculosis
SURGERIES:
h/o head injury 15yrs back when patient was diagnosed with intracranial bleed and was taken for surgery.
PERSONAL HISTORY:
He takes vegetarian diet, with normal appetite and regular Bowel and bladder habits
He started smoking 15years back and smokes 3 packs per day and he is a alcoholic since 15years
No known allergies
Family history: No significant family history
GENARAL EXAMINATION
Patient was conscious, coherent, cooperative
Patient looks obese
He has bilateral pedal edema
No Pallor, Icterus, Clubbing, Cyanosis, Lymphadenopathy
There were no signs of dehydration
VITALS:
Temperature: afebrile
SPO2: 90% at room air
Pulse rate: 94 bpm
Respiratory rate: 18/min
BP: 160/100 mmHg
SYSTEMIC EXAMINATION
CVS
- S1 and S2 heard
- No murmurs
Respiratory System
- Trachea is in central position
- Bilateral air entry present
- Normal Vesicular breath sounds heard
Per Abdomen
- Obese abdomen
- No tenderness
- No palpable mass,
- No organomegaly
- Bowel sounds are heard
CNS
- Conscious and normal speech
- Normal gait
- Cranial nerves normal
- Sensory system normal
- Motor system normal
- No signs of meningeal irritation.
INVESTIGATIONS:
PROVISIONAL DIAGNOSIS :
Left lower limb cellulitis with sepsis with k/c/o DM type 2 since 5 months with COPD with OSA with hypokalemia with mild ARDS
TREATMENT:
• On day 0
Left lower limb cellulitis with sepsis with k/c/o DM type 2 since 5 months with COPD with OSA with hypokalemia with mild ARDS
TREATMENT:
• On day 0
VITALS
Temperature - 98F
BP - 140/790 mmHg
PR - 94 bpm
SpO2 - 85% at RA
GRBS - 121mg/dl
Treatment given
- Proped up posture
- O2 inhalation @ 4-6 47/min
- Inj. MEROPENAM 1g/iv/BD
- inj. CLINDAMYCIN 600 mg /iv
- Inj. PAN 40 mg /od
- Inj. ZOFER 4 mg /iv/tid
- Inj HAI s/c acc to GRBS
- Neb. DUOLIN 5th hrly and BUDEEORT 12th hrly
- Inj LEVIPIL 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER )
- Syp. POTCHLOR 10 ml 1 Glass of WATER /PO/BD
Day 1
- O2 inhalation @ 4-6 47/min
- Inj. MEROPENAM 1g/iv/BD
- inj. CLINDAMYCIN 600 mg /iv
- Inj. PAN 40 mg /od
- Inj. ZOFER 4 mg /iv/tid
- Inj HAI s/c acc to GRBS
- Neb. DUOLIN 5th hrly and BUDEEORT 12th hrly
- Inj LEVIPIL 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER )
- Syp. POTCHLOR 10 ml 1 Glass of WATER /PO/BD
Day 1
VITALS
Temperature- 98.6F
BP - 150/90 mm Hg
PR - 96bpm
SpO2 - 84% at RA and 96% at 6L of O2
GRBS - 140 mg/dl
Treatment given
- proped up posture
- O2 inhalation @ 4-6 47/min
- INJ. MEROPENAM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDEEORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (D1ABEAC PROTIEN POWDER )
Day 2
- O2 inhalation @ 4-6 47/min
- INJ. MEROPENAM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDEEORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (D1ABEAC PROTIEN POWDER )
Day 2
VITALS
Temperature- 99 F
BP - 140/90 mmHg
PR - 89 bpm
SpO2 - 96 at 6L of O2
GRBS - 133 mg/dl
Treatment given
- proped up posture - O2 inhalation @ 4-6 47/min
- INJ. MEROPENAM 1g/iv/BD
- INJ. CLINDAMYCIN 600 mg /iv
- INJ. PAN 40 mg /od
- INJ. ZOFER 4 mg /iv/tid
- INJ HAI s/c acc to GRBS
- NEB. DUOLIN 5th hrly and BUDEEORT 12th hrly
- INJ. LEVIPIL 500mg / Iv/BD
- INJ. CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (DIABEAC PROTIEN POWDER )
Patient was referred to psychiatrist i/v/o h/o chronic smoking and chronic alcoholism, for which psychiatrist has added
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 3
VITALS
Temperature- 99 F
BP - 140/90 mmhg
PR - 102 bpm
SpO2 -
GRBS - 125 mg/dl
Treatment given
proped up posture - O2 inhalation @ 4-6 47/min
- Inj. meropenam 1g/iv/BD
- inj. clindamycin 600 mg /iv
- Inj. pan 40 mg /od
- inj. zofer 4 mg /iv/tid
- inj HAI s/c acc to GRBS
- neb. duolin 5th hrly and budeeort 12th hrly
- inj levipil 500mg / Iv/BD
- inj CLEXANE 40mg /sc /od
- IVF 1 NS, 1 RL@75ml per hr
- 2egg white /day
- piotein powder in 1 glass of milk/po/bd (D1ABEAC PROTIEN POWDER )
- TAB. PREGABALINE
- TAB. BENXL
- NICOTINEX CHEWING GUMS
Day 4
VITALS
Temperature- 98F
BP - 130/80 mmhg
PR - 94 bpm
SpO2 - 99 % at 6L of O2
GRBS - 122 gm/dl
Treatment given
DIABETES DIET INJ MEROPENEM
INJ CLINDAMYCIN 600MG / IV/TID
INJ PAN 40 MG /1V/TID
INJ ZOFER 4MG /4MG /1V /BD
INJ HAI S/C ACC TO GRBS
INJ LEVIPIL 900 MG /1V/BD
INJ CLEXANE 40 MG /SC /OD
TAB. PREGABALINE
TAB. BENXL
NICOTINEX CHEWING GUMS
Day 5
No new complaints
VITALS
Temperature- 98.5 F
BP - 140/80 mmHg
PR - 89 bpm
SpO2 - 98 % at 6L of O2
GRBS - 130 gm/dl
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 6
He has complaint of 3 episodes of loose stools
VITALS
Temperature- 98.5 F
BP - 130/80 mmHg
PR - 84 bpm
SpO2 - 98 % at 6L of O2
GRBS - 122 gm/dl
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 7
C/o Loose stools subsided
VITALS
Temperature- 98 F
BP - 110/60 mmHg
PR - 100 bpm
SpO2 - 98 % at 6L of O2
GRBS - 96 gm/dl
Treatment given
- Proped up posture
- IV Fluids 2NS and 2RL at 75ml/hr
- IV Fluids 2NS and 2RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. AMLONG 10mg PO/OD
- TAB. SPOROLAC- DS PO/BD
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 8
No new complaints
VITALS
Temperature- 100 F
BP - 150/100 mmHg
PR - 94 bpm
SpO2 - 96 % at 6L of O2
GRBS - 101 gm/dl
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD/PO
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD/PO
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 9
No new complaints
VITALS
Temperature- 98.5 F
BP - 130/80 mmHg
PR - 84 bpm
SpO2 - 98 % at 4L of O2
GRBS - 122 gm/dl
Treatment given
- Proped up posture
- IV Fluids 2NS and 1RL at 75ml/hr
- IV Fluids 2NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- INJ. PIPTAZ 4.5g/IV/TID
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- TAB. SPOROLAC- DS PO/BD
- ORS sachet in 1 liter of water after passing each stools
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 10
No new complaints
VITALS
Temperature- 98.5F
BP - 140/90 mmHg
PR - 85 bpm
SpO2 - 98 % at 2L of O2
GRBS - 116 gm/dl
Treatment given
- Propped up posture
- IV Fluids 1NS and 1RL at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- TAB. AUGMENTIN 625mg PO/OD
- TAB. CHYMEROL FORTE BD/PO
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 11
No new complaints
VITALS
Temperature- 98 F
BP - 130/90 mmHg
PR - 82 bpm
SpO2 - 88 % at Ra
GRBS - 117 gm/dl
Treatment given
- Propped up posture
- IV Fluids 1NS at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- TAB. CHYMEROL FORTE BD/PO
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 12
No new complaints
VITALS
Temperature- 98 F
BP - 150/90 mmHg
PR - 80 bpm
SpO2 - 88 % at Ra
GRBS - 120 gm/dl
Treatment given
- Propped up posture
- IV Fluids 1NS at 75ml/hr
- plenty of oral fluids
- Intermittent CPAP 4th hourly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. CLEXANE 60mg SC/OD
- TAB. CHYMEROL FORTE BD/PO
- TAB. REDORIL100mg PO/BD
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. AMLONG 10mg PO/OD
- 3 egg white /day
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
- Protein powder in 1 glass of milk/po/bd (DIABETIC PROTIEN POWDER)
Day 13
No new complaints
VITALS
Temperature- 98 F
BP - 150/100 mmHg
PR - 90 bpm
SpO2 - 94 % at Ra
GRBS - 116 gm/dl
Treatment given
- Propped up posture
- plenty of oral fluids
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- TAB. CHYMEROL FORTE BD/PO
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. TELMA AM 40/5mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- 3 egg white /day
Day 14
No new complaints
VITALS
Temperature- 98 F
BP - 140/90 mmHg
PR - 110 bpm
SpO2 - 94 % at Ra
GRBS - 120 gm/dl
Treatment given
- Propped up posture
- plenty of oral fluids
- INJ. PAN 40 mg /OD
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- INJ. HAI SC acc to GRBS
- NEB. IPRAVENT and BUDEEORT 8th hrly
- TAB. CHYMEROL FORTE BD/PO
- TAB. PREGABALINE PO/ H/S
- TAB. BENXL PO/OD
- NICOTINEX CHEWING GUMS PO/OD
- TAB. LEVIPIL 500mg PO/BD
- TAB. LEVIPIL 500mg PO/BD
- TAB. DOLO 650mg PO/SOS
- TAB. TELMA AM 40/5mg PO/OD
- SYP. POTCHLOR 15ml in 1glass of water PO/OD
- 3 egg white /day
