65M with pulmonary kochs with DM2
DOA :9/12/2022
Discharge Date:16/12/22
Ward:MMW
Unit:GM 5
Diagnosis
PULMONARY KOCHS WITH UNCONTROLLED DIABETES TYPE 2 SINCE 20 YRS WITH HTNSINCE 20 YRS
Case History and Clinical Findings
PT CAME TO THE CASUALTY WITH CHIEF COMPLAINTS IF HEMOPTYSIS FROM 3MONTHS.PATIENT WAS APPARENTLY ASYMPTOMATIC 15 YRS BACK WHEN HE STARTED TODEVELOPTINGLING SENSATION IN B/L UL AND LL AND GIDDINESS ON WAKING UP EARLY INTHE MORNING.HE THEN DEVELOPED DIMINISION OF VISION IN THE LEFT EYE SINCE 5YRS.SINCE 8 MONTHS, HE HAS BEEN HAVING FEVER ASSOCIATED WITH CHILLS,CONTINUOUS TYPE, LOW GRADE, ASSOCIATED WITH BURNING MICTURATION, NOTASSOCIATED WITH ANY DIURNAL VARIATION .6 MONTHS AGO, HE BEGAN TO DEVELOPCOUGH WITHOUT SPUTUM BUT GRADUALLY BECAME PRODUCTIVE, WHERE SPUTUM WASMUCOID, WHITISH YELLOW. THEN, IT PROGRESSED TO BLOODY SPUTUM SINCE 3 MONTHS
.SOMETIMES COUGH IS FOLLOWED BY VOMITING EPISODES WITH VARIABLECONTENTS.H/O WT LOSS OF 20KG IN 6 MONTHSASSOCIATED WITH CONSTIPATION. (PASSES STOOLS ONCE IN 3 DAYS )SINCE 3 MONTHS, HE HAS BEEN HAVING EPISODES OFVOMITINGS, 1 EPISODE AFTER FOOD EVERYDAY WITH FOOD AS CONTENT.HE ALSOCOMPLAINS OF DRY MOUTH, POLYPHAGIA, POLYDYPSIA, POLYURIA, NOCTURIA.NOCOMPLAINTS OF LOSS OF APPETITE.HE IS A K/C/O DM TYPE 2 SINCE 20 YRS AND IS ON TABGLYPIZIDE+METFORMINAND HTN AND IS ON TAB ATEN-AT 25/10NOT K/C/O EPILEPSY,ASTHMA, TB,CVA,CADGENERAL EXAMINATION:DONE AFTER OBTAINING CONSENT, IN THEPRESENCE OF ATTENDER, WITH ADEQUATE EXPOSUREHE IS CONSCIOUS, COHERENT,COOPERATIVE, WELL ORIENTED TO TIME PLACE, MODERATELY BUILT AND NOURISHEDNOPALOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA
VITALS AT ADMISSION:
TEMP: 98PR: 88BPMRR: 20CPMBP: 110/90MMHGSPO2: 98% AT RAGRBS:410MG/DL
SYSTEMIC EXAMINATION:
CVS: S1, S2 HEARD
PA: SOFT, NON TENDER, BSPRESENT
CNS: NO FOCAL ABNORMALITIES
INSPECTION:TRACHEA TO THERIGHTPALPATION:DECREASED BREATH MOVEMENTS ON THE RIGHT
PERCUSSION:RIGHTMAMMARY DULL, REST RESONANTAUSCULTATION:
INCREASED BREATH SOUNDSON RIGHT SIDE, VESICULAR BREATH SOUNDS HEARD, NOCREPTS, NO RONCHI
Investigation
COURSE IN THE HOSPITAL:
PATIENT WAS BROUGHT TO THE GENERAL MEDICINE DEPARTMENT ON 9/12/22 IN VIEW OFHEMOPTYSIS SINCE 3 MONTHS AND COUGH SINCE 6 MONTHS. HE IS A K/C/O DM TYPE 2AND HTN SINCE 20 YRS
SPUUM CULTURE AND SENSITIVITY WAS DONE AND ACID FAST BACILLI WERE SEEN ON10/11/22
SPUTUM AS SENT FOR RNTCP ON 12/12/22
ACCORDING TO HIS WT, PATIENT WAS STARTED ON ATT ON 12/12/22
S/C HAI INJECTIONS ARE ALSO BEING GIVEN FOR HIS DIABETES
HE WAS HAVING HYPOGLYCEMIC EPISODES FOR WHICH 25D HAD BEEN GIVEN ANDREGULAR GRBS MONITORING WAS DONE
NOW PT IS STABLE AND READY FOR DISCHARGE
HEMOGRAM:
HB: 10.1
TLC: 12,000
N/L/M/E/B: 85/10/5/0/0PLT: 2.9 LAKH
C/S REPORT OF SPUTUM:
PLENTY OF GRAM POSITIVE COCCI IN PAIRS AND CHAINS, FEW GRAM POSITIVE BACILLIAND FEW GRAM NEGATIVE BACILLI SEEN
ACID FAST BACILLI SEEN.
BLOOOD AND URINE C/S: NO GROWTH2D ECHO:
TRIVIAL TR, NO AR/MR
NO RWMA, NO AS/MS, SCLEROTIC AVGOOD LV SYSTOLIC FUNCTIONDIASTOLIC DYSFUNCTION NO PAH/PEXRAY CHEST:
CONSOLIDATORY CHANGES NOTED IN RT UPPER AND MIDDLE LOBES, LIKELYCONSOLIDATION.
PATCHY OPACIFICATION NOTED IN LT HILAR REGION, LIKELY INFECTIVE ETIOLOGYUSG ABDOMEN:
HYPERECHOIC FOCI NOTED IN MINIMALLY DISTENDED GALL BLADDER
Treatment Given(Enter only Generic Name)
TAB ATT 3 TABLETS ACC TO WTTAB INH 225MG PO OD
TAB RIFAMPICIN 450 MG PO OD
TAB PYRAZINAMIDE 1200 MG PO ODTAB ETHAMBUTOL 825 MG PO OD
TAB BENADON 40MG PO OD
INJ HAI S/C TID 14-14-12, NPH S/C BD 10-X-8 ACC TO GRBS
INJ VIT K 1 AMP IN 100ML NS
INJ TRANEXA 500ML IV SOS
INJ AMLONG 5MG PO OD
SYP GRYLLINCTUS 10ML PO TID
SYP EPTUS 5ML PO BD
Advice at Discharge
TAB ATT 3 TABLETS ACC TO WTTAB INH 225MG PO OD
TAB RIFAMPICIN 450 MG PO OD
TAB PYRAZINAMIDE 1200 MG PO ODTAB ETHAMBUTOL 825 MG PO OD
TAB BENADON 40MG PO OD
INJ HAI S/C TID 14-14-12, NPH S/C BD 10-X-8 ACC TO GRBS
TAB AMLONG PO OD
SYP GRYLLINCTUS 10ML PO TID
