ALTERED SENSORIUM SECONDARY TO ? SEPTIC ENCEPHALOPATHY WITH UTI ? TB MENINGO ENCEPHALIIS WITH PRE RENAL AKI ON CKD WITH HEALING GLUTEAL ABSCESS WITH HTN WITH LATE ONSET PSYCHOSIS WITH ANEMIA OF CHRONIC DISEASE WITH GRADE II BEDSORE WITH HYPOKALEMIA

Case History and Clinical Findings 
PT C/O FEVER,ALTERED SENSORIUM,LOSS OF APPETITE SINCE 2 DAYS. PT WAS APPARANTLY ASYMPTOMATIC 2 DAYS AGO THEN SHE HAD FEVER WHICH WAS HIGH GRADE, NOT ASSOCIATED WITH CHILLS, RIGORS.RELIEVED WITH MEDICATION.NO DIURNAL VARIATION. ALTERED SENSORIUM SINCE 2 DAYS. IRRELEVANT BLACK OUT , NOT ABLE IDENTIFY ATTENDERS. NO H/O LOSS OF CONSCIOUSNESS,INVOLUNTARY MOVEMNENTS, WEAKNESS IN BOTH UPPER AND LOWER LIMBS.LOSS OF APPETITE PRESENT N/H/O CHEST PAIN,SOB,PALPITATIONS,PEDAL EDEMA. N/H/O COUGH,BURNING MICTURITION K/C/O HTN ON TAB.ATENOLOL K/C/O CKD ON CONSERVATIVE MANAGEMENT K/C/O AKION CKD SECONDARY TO RUPTURED GLUTEAL ABSCESS WITH K/C/O LATE ONSET PSYCHOSIS H/O BLOOD TRANSFUSION- FFP TRANSFUSION GENERAL EXAMINATION-
PT IS DROWSY AROUSABLE WITH DEEP PAIN STIMULATION NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,OEDEMA. 
BP: 100/60MMHG PR : 98BPM RR : 24 CPM SPO2 : 97% GRBS : 148 MG% I/O : 2500/1300 SYSTEMIC EXAMINATION
 CVS : S1 S2 HEARED ,NO MURMURS
 RS: BAE +, NVBS HEARD 
PA : SOFT,NT 
CNS : GCS : E2 V2 M4 
POWER UL AND LL NOT ELICITABLE 
TONE UL AND LL NORMAL 
ON BOTH RT AND LT SIDE REFLEXES B T S K A P RT 2+ 2+ 1+ 2+ 1+ ELEVATED LT 2+ 2+ 1+ 2+ 1+ ELEVATED
 Investigations-:
24/8/23 HB 8.6 TLC 21,000 N/L/E/M/B 69/22/1/8/0 PLT 3.32 LAKHS 

25/8/23 
HB 14
TLC 16,400
 N/L/E/M/B 83/7/1/9/0 
PLT 4.85 LAKHS
 SR CR 3.1 
BLOOD UREA 109
 NA 140 
K 3.8

CL 101 
SR CA 10.1
 LUMBAR PUNCTURE DONE 
CSF : SUGAR 61 
PROTEIN 15 
AOA 15
 26/8/23
 HB 8.4 
TLC 32,200
 N/L/E/M/B 87/4/0/9/0 
PLT 3 LAKHS 
SR CR 2.7
 BLOOD UREA 106
 NA 139
 K 4.1
 CL 101
 27/8/23
 HB 8.2 
TLC 28,000
 N/L/E/M/B 90/7/3/0 
PLT 2 LALHS 
SR CR 2.5 
BLOOD UREA 111 
NA 138 
K 4.2
 CL 101 
28/8/23 
HB 8.6 
TLC 27,000 
N/L/E/M/B 88/6/0/6/0
 PLT 1.8 LAKHS 
SR CR 2.2 
BLOOD UREA 115 
NA 143
CL 101
 SR CA 10.1 
LUMBAR PUNCTURE DONE CSF : SUGAR 61
 PROTEIN 15 
AOA 15 
26/8/23
 HB 8.4 
TLC 32,200 
N/L/E/M/B 87/4/0/9/0 
PLT 3 LAKHS 
SR CR 2.7 
BLOOD UREA 106
 NA 139 
K 4.1
 CL 101
 27/8/23
 HB 8.2 
TLC 28,000 
N/L/E/M/B 90/7/3/0
 PLT 2 LALHS 
SR CR 2.5 
BLOOD UREA 111 
NA 138 
K 4.2
 CL 101 
28/8/23
 HB 8.6 
TLC 27,000 
N/L/E/M/B 88/6/0/6/0 
PLT 1.8 LAKHS
 SR CR 2.2 
BLOOD UREA 115 
NA 143
K 3.3
 CL 98
 TB 1.20 
DB 20 
AST 13 
ALT 12 
29/8/23 
HB 8.1 
TLC 28,400
 N/L/E/M/B 90/6/1/3/0 
PLT 2.3LAKHS 
30/8/23
 TLC 58000 
31/8/23 
HB 8.4
 TLC 70,000 
N/L/E/M/B 92/5/0/3/0 
PLT 2.7 LACS 
1/9/23
 HB 7.4 
TLC 60,000 
N/L/E/M/B 92/5/0/3/0
 PLT 2.0 LAKHS
 ECG WAS DONE
 CHEST X RAY WAS DONE
 2D ECHO ON 24/8/23 MILD AR +, MILD TR + WITH PAH NO RWMA . NO AS/MS.SCLEROTIC AV GOOD LV SYSTOLIC FUNCTION DIASTOLIC DYSFUNCTION . NO PE
 REVIEW 2D ECHO ON 29/8/23 MILD GLOBAL HYPOKALEMIA MILD TRWITH PAH , MODERATE AR , NO MR SCLEROTIC AV NO AS/MS
EF= 52 FAIR LV FUNCTIONS DIASTOLIC DYSFUNCTION , NO PE IVC SIZE NON COLLAPSING 
USG DONE 25/8/23 B/L GRADE I-II RPD CHANGES 
MRI BRAIN PLAIN WAS DONE 29/8/23 DIFFUSE CEREBRAL ATROPHY CHRONIC SMALL VESSEL ISCHEMICCHANGES OLD LACUNAR INFARCTS IN RT CAUDATE AND RT LENTIFORM NUCLEUS.
Diagnosis 
ALTERED SENSORIUM SECONDARY TO ? SEPTIC ENCEPHALOPATHY WITH UTI ? TB MENINGO ENCEPHALIIS WITH PRE RENAL AKI ON CKD WITH HEALING GLUTEAL ABSCESS WITH HTN WITH LATE ONSET PSYCHOSIS WITH ANEMIA OF CHRONIC DISEASE WITH GRADE II BEDSORE WITH HYPOKALEMIA
 Treatment Given-:
 RT FEEDS : 100ML WATER 2ND HRLY,200ML MILK 4 TH HRLY
 IV FLUIDS UO+ 30ML /HR
 INJ. MEROPENEM 500MG /IV/BD 
INJ. PAN 4O MG/IV/OD
 T. OROFER XT / OD 
INJ.CLEXANE 40MG/SC/OD 
SYP.POTLOR 15ML /RT/TID 
T.NODOSIS 500MG /RT/OD
 INJ.OPTINEURON 1AMP /NS
 BP,PR,RR,SPO2 MONITORING 2ND HRLY TEMP MONITORING 4 TH HRLY STRICT I/O CHARTING FREQUENT POSITION CHANGE REGULAR DRESSING OF ABSCESS ,BEDSORE

 Advice at Discharge 
RT FEEDS : 100ML WATER 2ND HRLY,200ML MILK 4 TH HRLY 
IV FLUIDS UO+ 30ML /HR
 INJ. MEROPENEM 500MG /IV/BD 
INJ. PAN 4O MG/IV/OD 
T. OROFER XT / OD
 INJ.CLEXANE 40MG/SC/OD
 SYP.POTLOR 15ML /RT/TID 
T.NODOSIS 500MG /RT/OD 
INJ.OPTINEURON 1AMP /NS                             REGULAR DRESSING OF ABSCESS ,BEDSORE

Follow Up
REFERRED TO HIGHER CENTRE NOTES PATIENT AND PATIENT ATTENDERS HAVE BEEN EXPLAINED ABOUT PTS CONDITION THAT IS ? SEPTIC ENCEPHALOPATHY ?UTI? TB MENINGO ENCEPHALIIS WITH PRE RENAL AKI ON CKD WITH HEALING GLUTEAL ABSCESS WITH HTN WITH LATE ONSET PSYCHOSIS WITH ANEMIA OF CHRONIC DISEASE WITH GRADE II BEDSORE WITH HYPOKALEMIA. PT HAS BEEN REFERRED TO HIGHER CENTRE IN VIEW OF HEMATO ONCOLOGY OPINION.

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