THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THIS PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[4.41 pm, 19/12/2025] PPM 1: Summary: This is a record of a common viral fever also presenting with vestibular neuronitis like symptoms who had a second peak of fever due to a common nosocomial iatrogenic inflammation that is often confused with sepsis worsening and leads to overtreatment with antibiotics escalation when the actual management needs to focus on stopping iv and removing the lines.
Handwritten history on admission attached
[4.44 pm, 19/12/2025] PPM 1: After admission the same night post vomitings her BP fell gradually to 70/50 and then bounced back from 60/50 on iv fluids alone. @PPM3 @PPM4 @44FPA
[4.51 pm, 19/12/2025] PPM 1: However after two days of admission she developed another fever spike!
[4.53 pm, 19/12/2025] PPM 1: And then more spikes yesterday with a swollen left forearm that clinched the diagnosis. Before that she received antibiotics escalation when none were necessary in the first place!
Left iv line swelling
[4.54 pm, 19/12/2025] PPM 1: Diagnosis:
Viral labyrinthitis complicated by hypovolemia due to vomiting and later iv line thrombophlebitis
[4.57 pm, 19/12/2025] PPM 1: Over-testing and overtreatment due to medical uncertainty
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Age/Gender: 39 Years/Female
Address:
Discharge Type: Relieved
Admission Date: 15/12/2025 11:42 AM
Discharge Date: 20/12/2025 09:38 AM
Diagnosis
VIRAL PYREXIA, VIRAL GASTRITIS
Case History and Clinical Findings
C/O FEVER SINCE 6 DAYS, VOMITINGS -4 EPISODES PER DAY FOR 6 DAYS
HOPI: PATIENT WAS APPARENTLY ALRIGHT 6 DAYS BACK, THEN SHE DEVELOPED FEVER CONTINUOUS TYPE, ASSOCIATED WITH VOMITING 2-4 EPISODES PER DAY NON -PROJECTILE, NONBILIOUS, FOOD AND WATER AS CONTENT. NO H/O RASH OVER THE BODY, NO ABDOMINAL PAIN. H/O BURNING MICTURITION. NO H/O OTHER COMPLAINTS. PAST HISTORY: N/K/CO HTN, DM, EPILEPSY, THYROID, CVA, CDA, TB.
PERSONAL HISTORY - MARRIED, MIXED DIET, REGULAR BOWEL AND BLADDER HABITS, BURNING MICTURITION PRESENT, NO ALLERGIES, APETITE NORMAL, NO ADDICTION GENERAL EXAMINATION: NO PALLOR, NO ICTERUS, NO CYANOSIS, NO CLUBBING, NO LYMPHADENOPATHY, NO PEDAL EDEMA.
SYSTEMIC EXAMINATION CVS- S1 S2 PRESENT, NO MURMURS. RS-BAE +, NVBS, PER ABDOMEN SOFT NON-TENDER, CNS - NFND.
VITALS: - TEMP: 101F, BP: 100/70MMHG, RR: 28 CPM, PR:112BPM, SPO2: 99% AT RA, RBS-106 MG/DL.
OPHTHALMOLOGY REFERRAL WAS DONE I/V/O INCREASED ICT CHANGES.
IMPRESSION- NO RAISED ICT CHANGES NOTED.
Investigation
HEMOGRAM:(15/12/25) HB-11.9, PCV-39.3, TLC-11900, RBC-4.54, PLT-3.1
HEMOGRAM:(16/12/25) HB-11.9, PCV-39.3, TLC-11900, RBC-4.5, PLT-2.5
HEMOGRAM:(17/12/25) HB-10.8, PCV-32.8, TLC-11300, RBC-3.7, PLT-3.1
HEMOGRAM:(18/12/25) HB-11.0, PCV-32.8, TLC-14900, RBC-3.71, PLT-2.5
HEMOGRAM:(19/12/25) HB-11.2, PCV-32.9, TLC-13200, RBC-3.8, PLT-2.6
Page-2
KIMS HOSPITALS
RFT:(15/12/25) UREA-29, CREATININE-0.80, SODIUM-139, POTASSIUM-4.0, CHLORIDE-100
RFT:(16/12/25) UREA-22, CREATININE-0.80, SODIUM-138, POTASSIUM-4.0, CHLORIDE-98
RFT:(17/12/25) UREA-18, CREATININE-0.70, SODIUM-132, POTASSIUM-3.9, CHLORIDE-95
RFT:(19/12/25) UREA-28, CREATININE-0.60, SODIUM-138, POTASSIUM-3.4, CHLORIDE-97
LFT:(15/12/25) TB-0.99, DB-0.20, SGPT -13, SGOT-20, ALP -177, TP -6.7, ALB-3.37, GLO-3.33, A/G RATIO -1.01
CUE-COLOR PALE YELLOW, ALB-NIL, SUGARS NIL, PUS 2-1-2 CELLS, EPITHELIAL CELLS 1-2
SEROLOGY NEGATIVE
URINE CULTURE - NO PUS CELLS, NO BACTERIA SEEN.
BLOOD CULTURE - NO GROWTH AFTER 48HRS OF INCUBATION
ESR:80 mm/1st hour
2D ECHO (16/12/25): IMPRESSION-: TRIVIAL TR, NO PAH, TRIVIAL MR/AR, NO PR, NO RWMA, NO AS/MS, GOOD LV SYSTOLIC FUNCTION, NO DIASTOLIC DYSFUNCTION, NO PE, NO LV CLOT.
USG ABDOMEN (16/12/25)- NO SONOLOGICAL ABNORMALITY DETECTED.
Treatment Given (Enter only Generic Name)
1)INJ PIPTAZ 4.5GM IV/TID
2)INJ PAN 40MG IV/BD
3)INJ DOXY 100MG IV/BD
4)INJ PCM 1GM IV/SOS IF TEMP >101
5)INJ ZOFER 4GM 4GM IV/TID
6)TAB PCM 650MG PO/TID
7)ENTEROGERMINA ORAL SUSPENSION PO/TID
8)SYP UNIZYME 2SPOONS PO/BD (20ML)
Advice at Discharge
1)TAB DOXYCYCLINE 100MG PO/BD X 3 DAYS
2)TAB PAN 40MG PO/OD X 3 DAYS
3)TAB PCM 650 MG PO/SOS
4)TAB ZOFER 4MG PO/BD
5) TAB REJUNEX CD3 PO/OD (0-1-0) X 15 DAYS.
6)SYP UNIZYME 20ML PO/BD X 15 DAYS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE, DONOT MISS MEDICATIONS. In case of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: For Treatment Enquiries Patient/Attendant Declaration: - The medicines prescribed
and the advice regarding preventive aspects of care, when and how to obtain urgent care have been
explained to me in my own language.
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
Discharge Date
Date:20/12/25
Ward: FMW
UNIT: I
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