41 year old female with pleural effusion
A 41 year old female with
C/o fever since 10- 15 days
C/o loss of appetite since 10- 15 days
C/o generalised weakness since 10-15 days
Cough with expectoration since 10-15 days
HOPI: The patient was apparently asymptomatic 15 days back then she developed fever low grade a/w loss of appetite and genralised waekness.Cough with expectoration.
No H/o weight loss
No H/o night sweats, evening rise of temperature.
Past history
Not a k/c/o DM HTN TB CAD CVA Epilepsy Asthma
Personal history
Diet: Mixed
Appetite: Decreased since 15 days
B&B: Regular
Addictions: No addictions
O/E
General examination
Patient is C/C
BP: 120/80 mm hg
PR: 90 bpm
RR: 19 cpm
Temp: 97 F
GRBS: 121 mg/dl
SpO2: 98 % @ RA
Systemic examination
CVS-S1S2 +, No Murmurs
RS- BAE+ , left ISA Crepts +
P/A: Soft , NT
CNS: No FND
INVESTIGATIONS
ESR =90
PLEURAL FLUID
T.C:- 12,000 CELLS
D.C :- 80%
PLEURAL FLUID SUGARS - 97
PLEURAL FLUID PROTEIN = 5.5
SERUM PROTEIN = 7.8
SERUM LDH = 145
2D ECHO ON 26/1/2022:-
IMPRESSION:- EF:- 58% REMAINING NORMAL
PLEURAL FLUID ADA OUTSIDE 97 U/L
PLEURAL FLUID ADA = 23 U/L
PLEURAL FLUID CBNAAT = NEGATIVE
PLEURAL FLUID CYTOLOGY :-
IMPRESSION:- FEATURES ARE SUGGESTIVE OF INFLAMMATORY SMEAR
USG ABDOMEN ON 27/1/2022
IMPRESSION:- NO SONOLOGICAL ABNORMALITY
USG CHEST ON 27/1/2022:-
IMPRESSION:- LEFT MODERATE PLEURAL EFFUSION WITH UNDERLINING PASSIVE ATELACTASIS
CULTURE AND SENSITIVITY :- NO GROWTH AFTER 48HRS OF AEROBIC INCUBATION
ADVICED:-
THEREPEUTIC THORACOCENTESIS
CST
ATT - 2 TABLETS /DAY
2 EGG WHITES/ DAY
HIGH PROTEIN DIET
TREATMENT
2 TABLETS OF ATT DAILY:-
RIFAMPICIN:- 150MG
ISONIAZID:- 75MG
PYRAZINAMIDE:- 400MG
ETHAMBUTOL HYDROCHLORIDE:- 275MG
TOTAL - 900MG
EACH TABLET - 900MG
TWO TABLETS - 1800MG
COMBINATIONS OF 4 DRUGS
Tab PCM 650 mg PO/SOS
Tab.PAN 40 mg PO/OD
Tab. ZINCOVIT PO/BD
Tab. LIMCEE PO/BD
Syp GRILLINCTUS 10 ml PO/TID
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