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impression, what happen to the patient?? cause of high fever?

Posted In: I cannot get a diagnosis. 0 Replies
  • Posted By: kahn22
  • February 18, 2010
  • 06:16 PM

need help: impression, what happen to the patient?? cause of high fever?
8year old male
20 weeks PTA, patient have intermittent high-grade fever and chills for 4 days,then followed by chickenpox for 10days. Consultd and was given Amoxicillin & paracetaml (7days). No relief noted, followup reveald Urinary Tract Infection, given (Cotrimoxazole{5days}) fever was not relieved howevr.

18wks PTA,with the same symptoms, consulted anther phsycian and diagnosed to have Thypoid fever and UTI. admitted 3days, Chlorempenicol IV & paracetamol given, went home against medical advice due to financial reason.

17wks PTA still with highgrade fever and chills, was noted to have Multiple cervical lymphadenopathy and was said to have lung infection, admitted for 10days, work-ups done and X-ray all negative.

15wks PTA, admitted to Childrens Hosp, bcoz of persistence of high grade fever and chills, admitted for 12days was started with Rifampicin, Isoniazid, Pyrazinamide and Cloxacillin. impression was PTB.

11wk PTA still with above complaints with decreased appetite, diaphoresis, and abodminal pain noted in the epigastric area and vomitting of 1 tsp per bout every intake of food, yellowish and non-blood streaked,

1wk PTA with above signs and symptoms accompanied with abdominal enlargement, scrotal and bipedal edema, was given Cefaclor and Metronidazole (6days)
day of admission patient was noted to be in sever abominal pain prompting consult and was admitted immediately.

course in the ward:
on ER, patient was noted to be pale and tachynneic with intercostal retractions and subcostal retractions. rales both lung fields. complained also of svere abdominal pain.
referred to surgery servce, assesment was to consider primary peritonitis, Nephritic Syndrome and PTB.

10hours post admission still febrile and tachypneic. anisocaria was noted thus patient was intubated. requested Ultrasound, revealed normal, ABG revealed uncompensated metabolic acidosis with over corrected hypoxemia.

24hrs PA, coffee ground NGT revealed Melena, CBC shows anemia, leukocytosis, thrombocytopenia. deranged prothrombin time.

33hr PA, cleared of infectious service from milliary TB, patiend was GCS 8, hypotensive and poor pulses.

58hr PA, patient was gasping for air and cyanoti with no cardiac rate, CPR was started, given epinephrine, hooked to mechanical ventilation

60hr PA, went to CP arrest, CPR done but failed, patient pronounced dead..

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