52 Year old male with infective endocarditis secondary to UTI
NOTE- this is an ongoing case, the E-LOG will be updated as and when we find new information
This E-log has been created under the guidance of DR. Siddharth
CHIEF COMPLAINT –
A 52-year-old gentleman presented to the OPD with Cheif Complaints of
- abdominal distension from the past 7 days
- shortness of breath after having food from the past 7 days
HISTORY OF PRESENTING ILLNESS-
Patient was apparently asymptomatic
2 years back the patient had a Non - Healing Ulcer Injury to the Right foot and visited the local hospital and was diagnosed with Diabetes Mellitus Type -II and was started on TAB- GLIMY-M2 PO/OD
2 years back he complained of Tingling in the upper limbs up to the palms, in the lower limbs up to the knee,
15 Days back the patient presented to the casualty with Abdominal Distension NOT associated with pain, No nausea, No Vomiting, No loose stools
He was admitted 15 Days back for Alcoholic Liver Disease, Acute Kidney Injury secondary to Urinary Tract Infection, or Chronic Kidney Disease HEPATIC encephalopathy grade-II, he was discharged on resolving complications.
From the past 7 Days, He Complains of Abdominal Distension
For the past 5 days, he complains of Constipation and has not passed stools since
He Also complains of altered Sleep patterns from the past 5 Days
He has hiccups since today morning
HISTORY OF PAST ILLNESS
Known Case of
DM type -II
Chronic Kidney Disease
Hepatic encephalopathy Grade -I
DRUG HISTORY-
PERSONAL HISTORY -
FAMILY HISTORY -
GENERAL EXAMINATION -
SYSTEMIC EXAMINATION -
A. CARDIOVASCULAR SYSTEM
PROVISIONAL DIAGNOSIS -
?INFECTIVE ENDOCARDITIS
?HEPATIC ENCEPHALOPATHY GRADE-I
Known Case of
DM type -II
Chronic Kidney Disease
Hepatic encephalopathy Grade -I
DRUG HISTORY-
- TAB- GLIMY-M2 PO/OD,
- He has been consuming alcohol for the past 20 years 150 ml daily
- He has an altered sleep pattern for the past 5 days
- No family history of DM, hypertension, Heart disease, or Asthma
- The patient is conscious
- Icterus is present
- Oedema of the feet is present
- Absence of pallor, cyanosis, lymphadenopathy, Malnutrition, Clubbing
VITALS -
- Temperature- Afebrile
- Pulse rate- 92 beats per minute
- Respiration Rate- 24 cycles per minute
- BP-100/70 mmHg
- SPO2 at room air-90%
- GRBS 76 mg%
A. CARDIOVASCULAR SYSTEM
- S1, S2 heard
- No murmurs or thrills
- JVP- normal
- Ejection Systolic murmur is heard in all areas
- No Dyspnoea, wheeze
- Central position of the trachea
- vesicular breath sounds
- Distended abdomen
- Bowel sounds present
- no tenderness, palpebral mass, free fluid
- Conscious
- normal speech
- No signs of Meningeal irritaTION
- No abnormality detectedd in cranial nerves, motor system, sensory system
?INFECTIVE ENDOCARDITIS
?HEPATIC ENCEPHALOPATHY GRADE-I
?ALCOHOLIC LIVER DISEASE
INVESTIGATIONS -
A. BIOCHEMICAL INVESTIGATION-
1. SERUM ELECTROLYTES
3.BLOOD UREA
4. FASTING BLOOD SUGAR
5.POST LUNCH BLOOD SUGAR
6. SERUM CREATININE
7. LIVER FUNCTION TEST
2. COMPLETE URINE EXAMINATION
3. HEMOGRAM
C. 2-D ECHO REPORT
D.ULTRASOUND REPORT
E. ECG
TREATMENT
DAY 1-
- INJ PAN 40mg IV
- .INJ MONOCEF 2g IV
- INJ - VANCOMYCIN
- SALT RESTRICTION <2G/DAY
- FLUID RESTRICTION <1.5L/DAY
- INJ-LASIX 40mg IV
- INJ - ZOFFER 40mg IV
- SYRUP -LACTULOSE 1.5ml
- INJECTION THIAMINE IV
- TAB-BACLOFEN 10mg
THE PATIENT WAS REFERRED TO THE NEPHROLOGIST
on cross consultation, the following medications were prescribed -
1.INJ- LASIX 40mg IV
2.TAB NODOSIS 500mg
3. TAB. BIO -D3
4.IVF-NS-UO 30ml/hr
5. GRBS - 6th hourly
DAY 2-
1. RENAL FUNCTION TEST
BACTERIAL CULTURE AND SENVITY REPORT
DAY 4 -
- Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
- Procto clysis enema
- Inj. Pan 40 mg Iv/OD
- Inj. Thiamine 200mg in 100ml NS /BD
- Inj. HAI 6U S/C TID
- Inj - Augmentin 1.2g IV / TID
- TAB Ecospirin 150 mg
- Tab Clopidogrel 75mg
- Tab Atorvas 20 mg
DIFFERENTIAL DIAGNOSIS -
INFECTIVE ENDOCARDITIS with AV VEGETATIONS
SECONDARY TO UTI
with AKI
with ?UREMIC ENCEPHALOPATHY?SEPTIC ENCEPHALOPATHY
WITH ULCER OVER THE SOLE OF THE RIGHT LEG
WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES
ADVICE AT DISCHARGE -
- Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
- Inj. Pan 40 mg Iv/OD
- Inj. Thiamine 200mg in 100ml NS /BD
- Inj. HAI 6U S/C TID
- Inj. Augmentin 1.2 gm IV/TID
- Tab. Ecospirn 150mg PO/HS/SOS
- Tab. Clopidogrel 75mg PO/HS/SOS
- Tab. Atorvas 20mg PO/HS/OD added
LINKS WITH RELEVANT INFORMATION -
this article was used by me for comparison with the patient above in order to give my self a wider perspective of the case presentation of endocarditis
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