chest infection
TRANSCRIPT
51 year old female k/c/o AML treated with chemotherapy presented with:
Chief Complains: Fever with Cough & Sputum x 2 weeks sweating+
On Examination G/C:Fair VITALS: P:89/min
BP:80/40mmHg T:37.6C Chest:Rt. Sided Crepts+ RR:20/min CVS:S1,S2,M0 P/A:Soft,Tenderness around Rt. hypochondric area+ Rt. ileal Region+
JAUNDICE:Absent ANAEMIC:+ LYMPH NODE: Non Palpable CYANOSIS: Absent CLUBBING: Absent OEDEMA:Absent DEHYDRATION: Absent
Personal h/o:Negative Smoking and Alcohol
h/o
Medical h/o:No DM,HTN,HEPATITIS,PTB
Surgical h/o:Hysterectomy done 5 years back
INVESTIGATIONS
COMPLETE BLOOD COUNT:(Pancytopenia) WBC:1X10*9/L(N=42%),L(48%), RBC:2.55X10*12/L,HB:59g/L,MCV:81.82fl PLT:46X10*9/L, RET%:1.63%
RENAL FUNCTION TEST:Urea:3.15mmol/L,Cr:30umol/LNa:139mmol/L,K:4mmol/L
TREATMENT
Inj IMIPENEM 500mg iv tid
Tab ITRACONAZOLE 200 mg qd
Tan KETOTIFEN 2mg PO TID
OTHER Supportive management
Summary
Patient is a diagnosed case of AML previously received chemotherapy,persistent Leucopenia might have contributed to the severity of infection?
Currently being managed for Chest Infection!
Antifungal drug is being given for further prophylaxis.
DEBATABLE POINTS
IS PATENT PROGRESSING TO SEPSIS,SIRS?
Evaluation of Pleural Fluid is most for further management?
Blood c/s, Sputum c/s to select a proper antibiotic and isolating bacteria?
Does chronic prescription of G-CSF OR similar medicine improves the Leucocytes,Neutrophil count?