M Bhuvana phanindra, 8 semister, Roll no.74.
This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centred online learning portfolio and your valuable inputs on comment box is welcome .
In order to comprehend and analyse the severity of COVID this is a e-log of patient centred covid progression along with other newly discovered conditions such as Denovo diabetes.
Here is a reflection of my view on the case:
A 45 year old female came to hospital complaining of fever, Myalgia, shortness of breath, nausea, headache, productive cough with scanty sputum, and loss of appetite on 23/05/2021. All the symptoms started a week ago.
History of presenting illness:
Patient was apparently asymptomatic 1 week back later developed
Sudden onset of SOB on 14/05/2021 associated with high grade fever. Got tested for covid on 15/05/2021 by rt-pcr ,tested positive.
H/o primary contact from her daughter.
Past history:
No known history of DM, Hypertension, thyroid or any other chronic disease.
Personal history:
Married, homemaker.
Loss of appetite+ve.
Non-vegetarian,Bowel and bladder habbits normal assoc. With burning micturition
No know allergies,
Regular alcohol abuse with toddy.
Family history:
Daughter tested positive for COVID-19.
General physical examination:
Patient is well built and nourished, orientation to time and place.
No pallor
No icterus.
No cyanosis
No clubbing
No lymphadenopathy
No edema.
No signs of dehydration or malnutrition.
Trunkal obesity
Vitals:
Pulserate: 106beats /min
Bp: 110/70mm of Hg.
Respiratory rate: 19cycles /min
Spo2: 96 without any artificial O2.
Systemic examination:
CVS
S1 and S2 heart sounds heard.
No murmurs heard.
Respiratory system
Trachea is central in position.
The patient is dyspneic and wheeze is present.
Tubular breath sounds heard.
Crepts were heard.
CNS
Intact.
Abdomen:
Soft and non-tender
Bowel sounds normal.
Provisional Diagnosis:
Covid 19 pneumonia.
Investigations:
HR-CT
Ct revealed moderate lung involvement confirmed covid 19 pneumonia.
X-ray:
Bilateral lung involvement with hazziness indicative of pneumonia.
Complete blood picture:
Blood work showed no abnormality
Glycated haemoglobin:
Denovo diabetes
Renal function tests:
No renal involvement and no abromal electrolyte levels found
Liver function tests:
Alkaline phosphatase levels seem to be ELEVATED I.e 177 (N 40-140Iu/L)
ECG:
Regular rhythm, no abromal waves were seen.
Diagnosis:
COVID PNEUMONIA.
Treatment plan:
Head end elevation
Tab.pcm 600 mg po/bd
Plenty of oral fluids
IVF 20Ns
Spo2 maintain above 92%
Tab LIMCEE po/bd.
Inj NEOMOL 100ml/iv , if fever above
102°F
GRBS charting.
MONITOR VITALS.
Syrp. Ascoril. 100ml po/td
NEBULSATION.
Tab.PAN 40mg po/oD.
24/05/2021; patient was found to be diabetic, was able to breath on her own yet dyspnic.spo2 92% on RA.
25/05/2021; fever spike with head ache spo2 was gradually dropping to 90% on room air.
26/05/2021;(9th day of symptoms) in the morning patient was kept on 10lts of O2 due to drop in staturation, on 10lits now is saturation 96%.
GRBS-time.
515mg/dl-4pm- 12units insulin given
360mg/dl-8pm.
27/05/2021; (10th day of symptoms)patient was out of artificial O2 inhalation, 98% at room air.but blood glucose levels are still high.(hb1Ac 6.8) GRBS (306) @8am, Insulin 8units given.
GRBS-time.
306mg/dl-8am- 8units insulin given
301mg/dl- 4pm
367mg/dl-8pm
207mg/dl-2am
28/05/2021; (11th day of symptoms) spo2 slightly droped(86%on room air) patient adviced to change into NRBM , GRBS (186) @8am.
GRBS-time
184mg/dl-8am.
353mg/dl-2pm-12 units of insulin given.
341mg/dl-8pm.
29/05/2021; (12th day of symptoms) patient was dyspneic, at room air Spo2- 90%,given 3lits of oxygen Spo2 improved to 97%@8am.
GRBS-time
180mg/dl-8am.
30/05/2021: (13th day of symptoms) patient was able to maintain Spo2 over 90% at room temperature.
GRBS-TIME-insulin dose
185mg/dl-8am-6U
212mg/dl-2pm-8U
241mg/dl-8pm-10U.
31/05/2021:(14th day of symptoms) patient was stable , able to maintain Spo2 over 90% on room air, Spo2:94% on RA.@8am.yet blood sugar levels seem to be out of control so patient was started on NPH besides HAI
GRBS-TIME-INSULIN-NPH
195mg/dl-8am-6U-10U.
247mg/dl-1pm-8U.
238mg/dl.-3pm
246mg/dl-8pm-6U-10U.
180mg/dl-10pm.
1/06/2021.(15th day of symptoms) patient blood sugar levels showed decline with usage of NPH.
GRBS-TIME-insulin-NPH
201mg/dl-2am.
159mg/dl-8am-6U-10U.
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