A 40 year old female with shock and hypothyroid since 10 years

 General medicine

M.Devisree gupta

Roll no 81 

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Chief complaints 

40yr female with to casuality with complaints of

high grade fever since 5-6 days

C/o vomitings since yesterday

C/i loose stools since today .

History of presenting illness

Pt was apparently asymptomatic 5-6 days then she developed fever , sudden high grade not a/w chills and rigors , intermittent, releived temporarily on medication.

C/i vomiting since yesterday h/o 3-4 episodes , content good particles ,non bilious , non projectile , nausea present 

C/o abdominal bloating since yesterday

C/o SOB since yesterday , releived on lying down, 

No chestpain , palpitations PND orthopnea

C/o loose stools since today , watery consistency, 4-5 episodes ,small quantity, non blood stained , not associated with pain abdomen.

C/o epigastric pain since today , insidious onset , continuous , non radiating

Past history 

N/k/c/o HTN DM CVA CAD TB ATHMA

K/c/o Hypothyroidism since 10 years on tab. Thyronorm 100mcg /po/ od using irregularly since 15 days

On examination: 

Pt is c/c/c 

No pallor , icterus , cyanosis, clubbing, lympadenopathy, edema 

Vitals : 

PR: 124bpm

RR: 18cpm

BP: 70 systolic ( palpatory)

GRBS : 183mg%

CVS : S1 s2 heard no murmurs

RS BAE NVBS heard

P/A : epigastric tenderness present 

No free fluid.

Free chart

Investigations

Diagonsis

HYPOVOLEMIC SHOCK SEOCNDARY TO ACUTE GE (RESOLVED) 

? COMMUNITY AQUIRED PNEUMONIA

WITH ? LEFT LOWER LOBE PNEUMONIA (BACTERUA US ATYPICAL) 

WITH ACUTE CALCULUS CHOLECYSTITIS 

Treatment 

IV FLUIDS NS & RL @100ML/HR 

(D4) TAB. AZITHROMYCIN 500MG PO/OD 8AM

T. THYRONORM 100MCG PO/OD 

   (8AM- 15MINS BEFORE FOOD) 

INJ. DROTIN IM/SOS

INJ. PAN 40MG/IV/BD 

INJ. ZOFER 4MG IV/BD 

MONITOR VITALS 4TH HOURLY