A patient who is 45 yr old male came to OPD with chief complaints of fever since 2 days and blurring of speech since 1 day .

HISTORY OF PRESENT ILLNESS 

Patient is a daily wage worker by occupation  . Patient was apparently asymptomatic 2 years back then his appetite increased( about 5- 6 times a day ) for which he came to KIMS hospital and diagnosed with Diabetes.He used oral hypoglycemic drugs for first 6 months.Then from past 1.5 years he is on insulin.He was a chronic alcoholic since 25 yrs . he consumes more than 180ml / day . Urine output increased since 2 years about 10 times a day.

Decreased weight about 25kg since 2 years.

Then since 2 days he developed  fever which was high grade, continuos and associated with chills and rigor and also presence of neck stiffness and burning Micturition.Patient was also anemic for which he received blood transfusion

He developed slurring of speech since 1 day then he came to hospital the next day

   

HISTORY OF PAST ILLNESS 

Patient is a 

K/c/o DM

Not a k/c/o asthma , hypertension , CAD 


FAMILY HISTORY - not significant 

Bowel and bladder movements - normal

Micturition - buring 

Appetite - increased 

Sleep - normal 

Diet - normal 

GENERAL EXAMINATION 

Pallor - yes 

Clubbing - no 

Cyanosis - no 

Lymphadenopathy - no

Icterus - no 

VITALS 

Bp- 110/80 mmhg

Respiratory rate - 20/ min 

Pulse rate - 100/min

Temperature - 97

SPO2 - 98%

SYSTEMIC EXAMINATION 

CVS

No thrills and no murmurs 

Cardiac sounds S1 S2 heard

RESPIRATORY SYSTEM 

Trachea - central 

Wheezing - no

Dysnea - no

Breath sounds - vesicular 

CNS

Level of consciousness - conscious

Speech - slurred 

Signs of meningeal infection 

Neck stiffness - yes 

Kernings - postive 

PROVISIONAL DIAGNOSIS 

Viral meningitis 

With k/c/o DM since 2 yrs 

Investigations 







TREATMENT

Iv fluids NS/RL/DNS 75ml/hr

Inj..Meropenem 500 mg /Iv/BD

Inj.Neomol 1gm/iv/sos of temperature is 102 or more

Inj.HAI SK  acc to GRBS

Inj. Thiamine 200 mg /IV/BD

Inj.Vit K 10 mg SC OD

Tab.Dolo 650 mg 

Tab. Doxy 100 mg /PO

Inj.PAN 40mg /IV/ OD

Protein X powder 1 scoop + 100 ml milk 4th hrly

GRBS profile

BP/PR/Temp/SPO2 4th hrly
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