CASE DETAILS:

43 YEAR OLD ARRIVED WITH HIGH GRADE FEVER WITH SEVERE PAIN IN OCCIPITAL REGION, HEAVINESS AND PAIN IN EYES SINCE 1 DAY, ALONG WITH HEAVINESS OF LEGS.SINCE TODAY MORNING BODYACHE,LOWER BACKACHE AND NECK PAIN.

PT GIVES HISTORY OF CONSUMING ICE CREAM ON 13/10/2015 AT NIGHT

SEVERE HEAD PAIN < DRAFT OF AIR 3+

ALSO CHIILLINESS < DRAFT OF AIR 3+

CHILLS BEGINNING IN CHEST AND MORE FELT IN EARLY MORNING AROUND 4AM.

SINCE FEVER HAS STARTED GREAT DRYNESS OF LIPS AND TONGUE

DULLNESS,WEAKNESS 3+

PHYSICAL GENERALS:

APPETITE:DECREASED

THIRST DURING FEVER-VERY MUCH INCREASED

LIKES:SPICY

DISLIKES:COLD FOOD-IT IMMEDIATELY CAUSES COLD COUGH

PERSPIRATION-SCANTY

URINE :NORMAL

STOOLS:UNSATISFACTORY SINCE 2 DAYS

SLEEP-NORMAL

THERMALS:CHILLY PATIENT

O\E:

TEMP-101.4(ORAL)

PULSE-106bpm

BP-110/60 mmHg

RR-18/MIN

TONGUE-CLEAN

SYSTEMIC EXAMINATION:

RS-AEBE

CVS-NAD

P/A-MILD TENDERNESS AT UMBLICAL REGION

INVESTIGATION:

Hb-12.7 gm%

RBC-4 LAKH 25 THOUSAND

WBC-3,800

ABSOLUTE EOSINOPHIL COUNT-38

PLATELET COUNT-1,81,000

DENGUE-NS1Ag-POSITIVE

S.CREATININE-0.8

S.BILIRUUBIN-0.5

URINE ROUTINE-COLOUR-YELLOW

OCCULT BLOOD –PRESENT

PUS CELLS-1 TO 2

RBC-1 TO 2

EPITHELIAL CELLS – OCCASIONAL

REPERTORIAL TOTALITY:

1) GENERALS ->ICE CREAM ->AGGRAVATION

2) CHILLS ->BEGINNING IN ->CHEST

3) BACK ->PAIN ->FEVER DURING

4) CHILLS ->NIGHT ->MIDNIGHT AFTER

5) WEAKNESS ->FEVER DURING

6) STOMACH ->THIRST ->CHILL DURING

7) CHILL ->DESCENDING

REPERTORY SHEET:
 

REMEDY SELECTION-

ARS ALB 200 1ST DILUTION STAT DOSEACCESS REMEDY RESPONSE

FOLLOW UP CRITERIA:



FOLLOW UP:

15/10/2016

6PM
 

15/18/2016

8PM

15/10/2016

9:30 PM-
 

16/10/2015

TIME-8 AM

 

16/10/2016
11 AM-

TEMP-NORMAL AFEBRILE,
ALL COMPLAINTS-BETTER 90%,APPETITE AND THIRST-INCREASED-CONTINUE ARS ALB 4 HOURLY.GENERAL FEELING OF WELLBEING PRESENT

CASE DETAILS:

21 YEAR OLD MALE PATIENT REPORTED ON 5TH OCTOBER 2015 AT 11 PM IN INPATIENT DEPARTMENT WITH HIGH GRADE FEVER ALONG WITH CHILLS SINCE 5 DAYS.PT. WAS ATTENDED IMMEDIATELY,IV ACCESS WAS TAKEN AND BLOOD SAMPLE WAS SEND FOR INVESTIGATION AND PT WAS STARTED WITH IV FLUIDS INORDER TO PREVENT DEHYDRATION.

STAGE WISE CASE ANALYSIS:

CHILL STAGE:

CHILLS MORE AT 5 PM

CHILLS DESCENDING,BEGINNING IN CHEST

INTENSE BODYACHE DURING

BACKACHE AND EXTREMITY PAIN IN THIS STAGE >PRESSURE2+

THIRSTLESSNESS

HEAT STAGE:

HEAT ALL OVER THE BODY

BACKACHE >PRESSURE

INTENSE PAIN IN EXTREMITIES >PRESSURE3+

THIRSTLESSNESS3+

SWEAT STAGE:

AS IT IS PERSPIRATION ABSENT

PERSPIRATION ONLY ON TAKING MEDICINE.

PERSPIRATION RELIEVES ALL THE COMPLAINTS EXCEPT BACKACHE.

CONCOMITTANT:

ABDOMINAL MUSCLE SORENESS WHICH IS <PRESSURE2+

>FLEXING LIMBS

VOMITTING DURING FEVER <EATING AND DRINKING3+

PHYSICAL GENERALS:

APPETITE:GOOD

LIKES:CHICKEN3+,MUTTON3+,SPICY3+

DISLIKES:GREEN LEAFY VEGETABLES

THIRST:DECREASED

URINE:NAD

STOOLS:NAD

THERMAL MODALITY:CHILLY PATIENT

PHYSICAL EXAMINATION:

PULSE:94bpm

BP-120/70 mmHg

TEMP:101 F

TONGUE:THICKLY WHITE COATED

NO PALLOR,NO CYNOSIS,NO ICTERUS,NO LYMPHADENOPATHY

SYSTEMIC EXAMINATION:

P/A:

TENDERNESS IN EPIGATRIUM

ACUTE FEVER REPERTORIAL TOTALITY:

1)CHILL->CHILLINESS->EVENING

2)CHILL->CHILLINESS->BEGINNING->CHEST

3)EXTREMITIES->PAIN->FEVER DURING

4)BACKPAIN->PRESSURE AMELIORATES

5)ABDOMINAL PAIN->BENDING DOUBLE ->AMEL

6)STOMACH->VOMITTING->CHILL DURING

7)ABDOMEN PAIN->PRESSURE->AGG

8)STOMACH->THIRSTLESSNESS->HEAT DURING

REPERTORY SHEET:

 

REMEDY SELECTION:

SEPIA 200 1ST DILUTION 3TSP EVERY 2 HOURLY

AS IT COVERED CONTRADICTORY MODALITIES

LIKE BACKPAIN -> PRESSURE AMELIORATES

ABDOMEN PAIN -> PRESSURE -> AGG

CASE DETAILS:

18 YEAR OLD BOY REPORTED IN INPATIENT DEPT AT 5 PM ON 10TH AUGUST 2016 HAVING HIGH GRADE FEVER SINCE 4-5 DAYS WITH CHILLS

CHILLS BEGINS FROM ARMS(FOREARMS) AND HEADACHE FROM FRONTAL TO OCCIPITAL REGION LIKE BAND OR RING.PATIENT HAD INTENSE WEAKNESS

GIDDINESS WHILE WALKING BLACKENING IN FRONT OF EYES

DROWSINESS 2+ DUE TO FEVER WITH BODYACHE

THIRST -SCANTY

SWEAT -MORE ON FOREHEAD AND BACK REGION

COLD AND COUGH 4-5 DAYS BEFORE FEVER

A/F-TAKING COLD DRINKS,COUGH WITHOUT EXPECTORATION

EVENING RISE OF FEVER AT AROUND 7 PM

STARTS WITH CHILLS IN ARMS.

COVERS WHOLE BODY FROM HEAD TO FOOT

PHYSICAL GENERALS:

TASTE-BITTER

APPETITE-EASY SATIETY

FEW MORSALS SEEMS TO BE ENOUGH AND FILL THE STOMACH

THIRST -SCANTY

O\E-

PULSE -68(BRADYCARDIA)

BP-110\70 mmHg

RR-18\MIN

TEMP-103 F(ORAL)

NO PALLOR,NO ICTERUS,

THROAT EXAMINATION-NO CONGESTION

P\A-NORMAL

RS EXAMINATION-NORMAL

CVS-NORMAL

INVESTIGATIONS:

CBC-

HB-14.8

WBC-4800

PLATELET COUNT-1 LAKH 60 THOUSAND

MALARIAL PARASITE-NEGATIVE

WIDAL-NEGATIVE

DENGUE NS1Ag-NEGATIVE

URINE ROUTINE-

PUS CELLS-1-2

DENGUE IgM-NEGATIVE

DENGUE IgG-NEGATIVE

X-RAY CHEST PA VIEW-NORMAL

S.BILIRUBIN-0.8

FEVER TOTALITY:

1.PULSE-SLOW-FEVER WITH

2.CHILLS-BEGINNING IN-ARMS

3.FEVER-EVENING-19H

4.STOMACH -THIRSTLESSNESS-HEAT DURING

5.MIND-DULLNESS-HEAT DURING

REMEDY SELECTION:

GELSEMIUM 200 1ST DILUTION--> GELSEMIUM 1M IST DILUTION.

TUB 1M IST DILUTION GIVEN AT TWO INSTANCES AS STAT DOSE.

FOLLOW UP:

GELS 200 1ST DILUTION EVERY 15 MIN STARTED AT 6:30 PM

STRICT T/P/R/BP CHARTING EVERY 2 HOURLY

IVF:

1 PINT DNS +MVI

↓

1 PINT RL EACH OVER 6 HOURS

↓

1PINT DNS+MVI

FOLLOW UP CRITERIA

10/7/16 9PM

 

12 AM TEMP-102.2 F

AT 12:30 AM-PT SHIFTED FROM GELS 200 TO GELS 1M EVERY 30MIN

11/7/2016 6AM

 

1 PM TEMP-99.8 F

PULSE-70 BPM

AT 1:30 PM PT STOOD AND WALKED WITHOUT ANY GIDDINESS.

PT STABLE AND SYMPTOMATICALLY MUCH BETTER..CONTINUE GELS 1M EVERY

7 PM TEMP -100F(TEMP RANGE REDUCED AS COMPARED

11/7/2016 9 PM

 

12/7/16 6 AM
 

12/7/2016

6 PM -TUB 1M SINGLE DOSE GIVEN INORDER TO AVOID RECURRANCE

8:30 PM-

PT. AFEBRILE THROUGHOUT THE DAY

NO RESPIRATORY COMPLAINTS

NO HEADACHE

MUCH RELIEF SYMPTOMATICALLY

PT STABLE

VITALS NORMAL

PT DISCHARGED AT 10 PM-- ON DICHARGE TREATMENT –GELS 1M 1ST DILUTION 2 HOURLY