A 65/M with backache and burning micturition since 5 days.

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Here is a case i have seen:  

A 65 year old male patient farmer by occupation came to OP with complaints of  backache and burning micturition since 5 days,fever since 5 days
Patient was apparently asymptomatic 5 years back Then he had complaints of fever sudden in onset low grade type, Sweating and giddiness for which he went to local hospital where he was diagnosed with Hypertension and DM II.
Then,9 months ago He underwent jaboulay's surgery for Hydrocoele.Later 8 months ago,He devloped sudden weakness of right upper limb and was taken to hospital ,CT brain was done which came to be normal and was adviced physiotherapy due to which patient symptoms relieved within 2 weeks.
Now , patient came with complaints of fever since 5 days, insidious in onset, intermittent not associated with chills and rigor,no aggrevating features but relieved on medication,No diurnal variations. No H/O cold,cough,recent throat infection.H/O backache and burning micturition since 5 days No H/O night sweats, giddiness, weight loss.
Mixed diet, Appetite normal, Adequate sleep, regular Bowel movements,Occasionally alcohol consumption since 25 years(90-180ml) but daily consumption since 10 days.Chronic Smoker - 18beedis/day.
General Examination: 
Patient is conscious, coherent, cooperative, moderately built and moderately nourished.
No pallor ,Icterus, Cyanosis, Clubbing lymphadenopathy and pedal edema.
Vitals : temp -98.6F, PR-84bom,BP -140/90mmHg,RR-18cpm.
CVS : S1 S2 heard,no murmurs.
RS : BLAE+,NVBS+.
CNS : NAD.
P/A : soft ,non tender.


Investigations :
Provisional Diagnosis: 
Urosepsis with AKI K/C/O HTN,DM II.
Treatment :

Day 1-
INJ.PANTOP 40mg IV OD
INJ.PIPTAZ 2.25gm IV QID
IVF.NS @ 150ml/hr
IVF.RL @ 150ml/hr
INJ.HAI S/C after informing to PG
TAB. AMLONG 5 mg OD 8am
TAB.PCM 500 mg SOS
Monitor GRBS 4th hrly
Monitor Temp/BP/PR 4th hrly.

Day 2-
INJ.PANTOP 40mg IV OD
INJ.PIPTAZ 2.25gm IV QID
INJ.NPH 12IU 
INJ.Regular HAI 12IU
TAB. AMLONG 5 mg OD 8am
TAB.PCM 500 mg SOS 
Monitor GRBS 6th hrly.
Withhold OHA till further orders.

Day 3-
INJ.PANTOP 40mg IV OD
INJ.PIPTAZ 2.25gm IV QID
INJ.NPH at 8am-12IU and 8pm-12IU.
INJ. HAI :12IU 8am-12IU ,2pm-12IU,8pm -12IU
TAB. AMLONG 5 mg OD 8am
TAB.PCM 500 mg SOS
SYP.CREMAFFIN 15ml PO BD
Monitor GRBS 6th hrly.

Day 4 -
INJ.PANTOP 40mg IV OD
INJ.PIPTAZ 2.25gm IV QID
INJ.NPH at 8am-14IU and 8pm-14IU.
INJ. HAI :12IU 8am-16IU ,2pm-16IU,8pm -16IU
TAB. AMLONG 5 mg OD 8am
TAB.PCM 500 mg SOS
SYP.CREMAFFIN 15ml PO BD
Monitor GRBS 6th hrly.

Day 5-
INJ.PANTOP 40mg IV OD
INJ.PIPTAZ 2.25gm IV QID
INJ.NPH at 8am-14IU and 8pm-14IU.
INJ. HAI :12IU 8am-16IU ,2pm-16IU,8pm -16IU
TAB. AMLONG 5 mg OD 8am
TAB.PCM 500 mg SOS
SYP.CREMAFFIN 15ml PO BD
Monitor GRBS 6th hrly.

Day 6-
INJ.PANTOP 40mg IV OD
INJ.PIPTAZ 2.25gm IV QID
INJ.NPH at 8am-14IU and 8pm-14IU.
INJ. HAI :12IU 8am-16IU ,2pm-16IU,8pm -16IU
TAB. AMLONG 5 mg OD 8am
TAB.PCM 500 mg SOS
SYP.CREMAFFIN 15ml PO BD
Monitor GRBS 6th hrly.











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