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A 60 years old female presented in the casualty with complaints of chill associated fever and abdominal pain.
CHIEF COMPLAINTs
➤Fever for the past 6 days.
➤Decreased appetite for the past 6 days.
➤Pain abdomen for the past 3 days.
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 6 days ago after which she developed high grade fever associated with chills, but not associated with cold, cough and burning micturition.
6 days before patient developed decrease in appetite which was not associated with nausea,vomiting,diarrhoea,constipation and weight loss.
Pain abdomen which is diffused, radiating and pricking type which gets aggravated on right lateral position and patient gets relieved in sitting posture.
Patient visited nearby hospital in the view of above complaints.
USG Abdomen was done there.
IMPRESSION :- Mild hepatomegaly with multiple abscess .
HISTORY OF PAST ILLNESS
➤Not a known case of hypertension,diabetes,bronchial asthma,epilepsy.
➤k/c/o tuberculosis
DRUG HISTORY
➤No significant drug history.
PERSONAL HISTORY
➤Occupation: Daily waged labor working in Cotton fields.
➤Patient is married
➤Patient takes mixed diet but has a decreased appetite.
➤Bowel and bladder movement is normal and regular.
➤Intake of Alcohol
(180 ml twice a week).
FAMILY HISTORY
➤No significant family history.
ALLERGIC HISTORY
➤No significant allergic history
GENERAL EXAMINATION
➤Pallor : Not seen
➤Icterus : Not seen
➤Cyanosis : Not seen
➤Clubbing : Not seen
➤Lymphadenopathy : Not seen
➤Edema : Not seen
VITALS
➤Temperature : 101℉
➤PR : 108 beats per minute
➤BP : 100/70 mmHg
➤RR : 24 cycles per minute
➤SpO2 : 95% in room air
➤Blood Sugar (random) : 100mg/dl
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION
INSPECTION
➤Shape - Scaphoid
➤Umbilicus - Inverted
➤Equal movements in all the quadrants.
➤No visible pulsation, dilated veins and localized swellings.
PALPATION
➤Local rise of temperature in right hypochondrium.
➤Tenderness in epigastrium and right hypochondrium.
➤Guarding and rigidity in epigastrium and right hypochondrium.
➤Mild enlargement of liver.
PERCUSSION
➤Fluid thrill and shifting dullness absent
AUSCULTATION
➤Auscultatory findings are normal.
CARDIOVASCULAR SYSTEM EXAMINATION
➤s1 and s2 heard
➤Thrills absent.,
➤No cardiac murmurs
RESPIRATORY SYSTEM
➤Normal vesicular breath sounds heard.
➤Bilateral air entry present
CENTRAL NERVOUS SYSTEM EXAMINATION
➤Conscious and coherent
PROVISIONAL DIAGNOSIS : MULTIPLE LIVER ABSCESS
INVESTIGATIONS :
DAY 1
USG ABDOMEN
 |
USG REPORT
IMPRESSION-Multiple liver abscess
raised echogenicity of bilateral kidney
CT SCAN
DAY 2
 | | ➤Serum electrolytes are mildly reduced. |
 | | ➤SERUM CREATININE IS NORMAL |
 | | ➤BLOOD UREA IS NORMAL |
|
 |
| ➤COMPLETE URINE EXAMINATION |
 |
| APTT TEST:NORMAL |
 |
| ➤Prothrombin time is normal. |
 |
CBC-REDUCED HB-9.7gm/dl
TOTATL COUNT-13,900cells/cmm |
LYPMHPOCYTES-09%
 |
➤BACTERIAL CULTURE REPORT IS NORMAL
LFT(ELEVATED LEVELS)
TOTAL BILIRUBIN-2.45mg/dl
DIRECT BILIRUBIN-1.89mg/dl
ALBUMIN-2.5gm/dl
|
 |
➤ESR LEVEL IS HIGHLY ELEVATED - 110mm/1st hour
|
 |
| LIVER ABSCESS |
DAY 4 |
| REDUCED LEVEL OF ELECTROLYTE |
DAY 6 |
| REVIEW USG-45-55% LIQUEFACTION |
DAY 7 |
XRAY CHEST-POST TB CHANGES
 |
DAY 10
 |
ABDOMEN XRAY
TOTAL COUNT-13300cells/cmm
 |
 |
| ESR HIGHLY ELEVATED-120mm/1st hour |
DAY 11
 |
REVIEW USG-MULTIPLE LIVER ABSCESS
LIQUEFACTION RANGING FROM 45-55% |
DAY 14
 |
| COLOUR DOPPLER 2D ECHO |
TPR CHART
MANAGEMENT FOR HEPATIC ABSCESS
DAY 1
1) IV fluids -NS,RL,DNS @ 75 ml per hour
2) Inj. METROGYL 750 mg IV / TID
3) Inj. PANTOP 40 mg IV OD
4) Inj. ZOFER 4 mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100 ml NS slow IV /OD
6) Inj. OPTINEURON 1 AMP in 100 ml NS IV/OD
7) Tab. PARACETAMOL 650 mg PO/TID
8) BP / pulse rate / Body temperature monitoring 4th hourly regularly
9) GRBS monitoring 6th hourly regularly
10) Inj. MONOCEF 1gm IV/BD
11) Inj. AMIKACIN 250 mg IV/BD
DAY 2
1) Iv fluids -NS,RL,DNS @ 75ml per hour
2) Inj. METROGYL 750 mg IV / TID
3) Inj. PANTOP 40mg IV / OD
4) Inj. ZOFER 4mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD
7) Inj. MONOCEF 1gm IV / BD
8) Inj. AMIKACIN 250mg IV / BD
9) Tab PCM 650mg PO / TID
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
DAY 3
1) Inj. METROGYL 750mg IV/TID
2) Inj. PANTOP 40mg IV OD
3) Inj. ZOFER 4mg IV/SOS
4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD
6) Inj. MONOCEF 1gm IV / BD
7) Inj. AMIKACIN 250mg IV / BD
8) Tab PCM 650mg PO/TID
9) Tab LIMCEF PO / OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
DAY 4
1) Inj. METROGYL 750mg IV / TID
2) Inj. PANTOP 40mg IV OD
3) Inj. ZOFER 4mg IV/SOS
4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD
6) Inj. MONOCEF 1gm IV / BD
7) Inj. AMIKACIN 250mg IV / BD
8) Tab PCM 650mg PO / TID
9) Tab LIMCEF PO / OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
DAY 5
1) Inj. METROGYL 750mg IV/TID
2) Inj. PANTOP 40mg IV OD
3) Inj. ZOFER 4mg IV/SOS
4) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. MONOCEF 1gm IV/BD
7) Inj. AMIKACIN 250mg IV/BD
8) Tab PCM 500mg PO/TID
9) Tab LIMCEF PO/OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11)GRBS monitoring 6th hourly regularly.
DAY 6
1)IVF @ 75ml/hr
2) Inj. MONOCEF 1gm IV/BD
3. Inj. AMIKACIN 250mg IV/BD
4) Inj. METROGYL 750mg IV/TID
5) Inj. PANTOP 40mg IV OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
7) Inj. ZOFER 4mg IV/SOS
8) Tab. DOLO 650 mg/PO/SOS
9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
10) Tab LIMCEF PO/OD
11)TEMP CHARTING 4th hourly
DAY 7
1) Inj. MONOCEF 1gm IV/BD
2. Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) TAB.DOLO 650 mg/PO/SOS
10)TAB.ULTRACET 1/2 PO/QID
11) Tab LIMCEF PO / OD
12) BP / PR / TEMP-4 TH HOURLY
DAY 8
1) IVF @ 100 ml / hr
2) Inj. TAZAR 4.15gm
2. Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) TAB.DOLO 650 mg/PO/SOS
10) Tab LIMCEE PO / OD
11)BP / PR / TEMP-4 TH HOURLY
12)INJ.BUSCOPAN IM/SOS IF pain abdomen
DAY 9
1) IVF @ 100 ml / hr
2) Inj. .PIPTAZ 4.5gm IV TID
3) Inj. AMIKACIN 250mg IV/BD
4) Inj. METROGYL 750mg IV/TID
5) Inj. PANTOP 40mg IV OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
7) Inj. ZOFER 4mg IV/SOS
8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
10)TAB.DOLO 650 mg/PO/SOS
11) Tab LIMCEF PO / OD
12)Inj. .BUSCOPAN IM/SOS IF pain abdomen
13)BP / PR / TEMP-4 TH HOURLY
DAY 10
1) Inj. PIPTAZ 4.5gm IV TID
2) Inj. AMIKACIN 250 mg IV BD
3) Inj. METROGYL 750 mg IV TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) INJ.BUSCOPAN IM/SOS IF pain abdomen
10) TAB.DOLO 650 mg/PO/SOS
11) TAB.ULTRACET 1/2 PO/QID
12) BP / PR / TEMP-4 TH HOURLY
13) TEMP CHARTING
DAY 11
1) INJ.PIPTAZ 4.5gm IV TID
2)Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) Inj..BUSCOPAN IM/SOS IF pain abdomen
10) TAB.DOLO 650 mg/PO/SOS
11) TAB.ULTRACET 1/2 PO/QID
12) BP / PR / TEMP-4 TH HOURLY
13)TEMP CHARTING
DAY 12
1) Inj. PIPTAZ 4.5gm IV TID
2) Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) INJ.BUSCOPAN IM/SOS IF pain abdomen
10) TAB.DOLO 650 mg/PO/SOS
11) TAB.ULTRACET 1/2 PO/QID
12) BP / PR / TEMP-4 TH HOURLY
13) TEMP CHARTING
DAY 13
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Syp. LACTULOSE 15ml PO/TID
3) Inj. CLAVUM 1.2gm IV/BD
4) SOAP WATER ANEMA
5) Inj. PANTOP 40mg IV OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
7) Inj. ZOFER 4mg IV/SOS
8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
10) INJ.BUSCOPAN IM/SOS IF pain abdomen
11) TAB.DOLO 650 mg/PO/SOS
12) TAB.ULTRACET 1/2 PO/QID
13) BP / PR / TEMP. 4th HOURLY
14) TEMP CHARTING
DAY 14
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.DOLO 650 mg/PO/SOS
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 15
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.DOLO 650 mg/PO/SOS
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 16
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.PCM 500 mg/PO/TID
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 17
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.PCM 500 mg/PO/TID
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 18
1) Inj. MEROPENAM 1gm IV/BD
2) Inj. PANTOP 40mg IV OD
3) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
4) Inj. ZOFER 4mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
6) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
7) INJ.BUSCOPAN IM/SOS IF pain abdomen
8) TAB.PCM 500 mg/PO/TID
9) TAB.ULTRACET 1/2 PO/QID
10) BP / PR / TEMP. 4th HOURLY
11) TEMP CHARTING
DAY 19
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. ZOFER 4mg IV/SOS
5) TAB.PCM 500 mg/PO/TID
6) TAB.ULTRACET 1/2 PO/QID
7) BP / PR / TEMP. 4th HOURLY
8) TEMP CHARTING
DAY 20
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. ZOFER 4mg IV/SOS
5) TAB.PCM 500 mg/PO/TID
6) TAB.ULTRACET 1/2 PO/QID
7) BP / PR / TEMP. 4th HOURLY
8) TEMP CHARTING
DISCHARGE SUMMARY
>PATIENT GOT DISCHARGED ON DAY 20 WITH ADVISE FOR FOLLOW UP AFTER 15 DAYS.
CHIEF COMPLAINTs
➤Fever for the past 6 days.
➤Decreased appetite for the past 6 days.
➤Pain abdomen for the past 3 days.
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 6 days ago after which she developed high grade fever associated with chills, but not associated with cold, cough and burning micturition.
6 days before patient developed decrease in appetite which was not associated with nausea,vomiting,diarrhoea,constipation and weight loss.
Pain abdomen which is diffused, radiating and pricking type which gets aggravated on right lateral position and patient gets relieved in sitting posture.
Patient visited nearby hospital in the view of above complaints.
USG Abdomen was done there.
IMPRESSION :- Mild hepatomegaly with multiple abscess .
HISTORY OF PAST ILLNESS
➤Not a known case of hypertension,diabetes,bronchial asthma,epilepsy.
➤k/c/o tuberculosis
DRUG HISTORY
➤No significant drug history.
PERSONAL HISTORY
➤Patient is married.
➤Patient takes mixed diet but has a decreased appetite.
➤Bowel and bladder movement is normal and regular.
➤Intake of Alcohol
(180 ml twice a week).
FAMILY HISTORY
➤No significant family history.
ALLERGIC HISTORY
➤No significant allergic history
GENERAL EXAMINATION
➤Pallor : Not seen
➤Icterus : Not seen
➤Cyanosis : Not seen
➤Clubbing : Not seen
➤Lymphadenopathy : Not seen
➤Edema : Not seen
VITALS
➤Temperature : 101℉
➤PR : 108 beats per minute
➤BP : 100/70 mmHg
➤RR : 24 cycles per minute
➤SpO2 : 95% in room air
➤Blood Sugar (random) : 100mg/dl
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION
INSPECTION
➤Shape - Scaphoid
➤Umbilicus - Inverted
➤Equal movements in all the quadrants.
➤No visible pulsation, dilated veins and localized swellings.
PALPATION
➤Local rise of temperature in right hypochondrium.
➤Tenderness in epigastrium and right hypochondrium.
➤Guarding and rigidity in epigastrium and right hypochondrium.
➤Mild enlargement of liver.
PERCUSSION
➤Fluid thrill and shifting dullness absent
AUSCULTATION
➤Auscultatory findings are normal.
CARDIOVASCULAR SYSTEM EXAMINATION
➤s1 and s2 heard
➤Thrills absent.,
➤No cardiac murmurs
RESPIRATORY SYSTEM
➤Normal vesicular breath sounds heard.
➤Bilateral air entry present
CENTRAL NERVOUS SYSTEM EXAMINATION
➤Conscious and coherent
PROVISIONAL DIAGNOSIS : MULTIPLE LIVER ABSCESS
COURSE IN HOSPITAL
60/F came to our with c/of pain in upper quadrant since 2 days , fever since 1 day and decrease appetite and nausea for past 2 days ,on examination vitals were stable .p/A tenderness and guarding present in right hypochondrium and epigastric region. Routine blood investigations were done, X-ray showed post TB changes and USG showed multiple liver abscess with largest on right side segment 7 with 45-50% liquefaction and patient started on triple antibiotic therapy Inj. MONOCEF 1 gm iv BD, Inj. AMIKACIN 250 mg iv BD , and Inj. METRODINAZOLE 750 mg IV /TID and other symptomatic treatment . A review USG done and USG guided abscess aspiration was done on day 3 . Blood cultures and aspiration cultures turned out to be negative . Sputum for AFB and CBNAAT are negative . As the fever spikes are continued antibiotic escalated to Inj. PIPTAZ 4.5 gm iv TID. Patient 's appetite improved , nausea decreased. Surgery opinion was taken i/v/of pain abdomen and liver abscess suggested antibiotic therapy till liquefaction occurs.
Condition of the patient and recovery was clearly explained to the attenders and advised for discharge and follow up for every 15 days to medicine OPD.
TREATMENT GIVEN FOR HEPATIC ABSCESS
DAY 1
1) IV fluids -NS,RL,DNS @ 75 ml per hour
2) Inj. METROGYL 750 mg IV / TID
3) Inj. PANTOP 40 mg IV OD
4) Inj. ZOFER 4 mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100 ml NS slow IV /OD
6) Inj. OPTINEURON 1 AMP in 100 ml NS IV/OD
7) Tab. PARACETAMOL 650 mg PO/TID
8) BP / pulse rate / Body temperature monitoring 4th hourly regularly
9) GRBS monitoring 6th hourly regularly
10) Inj. MONOCEF 1gm IV/BD
11) Inj. AMIKACIN 250 mg IV/BD
DAY 2
1) Iv fluids -NS,RL,DNS @ 75ml per hour
2) Inj. METROGYL 750 mg IV / TID
3) Inj. PANTOP 40mg IV / OD
4) Inj. ZOFER 4mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD
7) Inj. MONOCEF 1gm IV / BD
8) Inj. AMIKACIN 250mg IV / BD
9) Tab PCM 650mg PO / TID
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
DAY 3
1) Inj. METROGYL 750mg IV/TID
2) Inj. PANTOP 40mg IV OD
3) Inj. ZOFER 4mg IV/SOS
4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD
6) Inj. MONOCEF 1gm IV / BD
7) Inj. AMIKACIN 250mg IV / BD
8) Tab PCM 650mg PO/TID
9) Tab LIMCEF PO / OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
DAY 4
1) Inj. METROGYL 750mg IV / TID
2) Inj. PANTOP 40mg IV OD
3) Inj. ZOFER 4mg IV/SOS
4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD
6) Inj. MONOCEF 1gm IV / BD
7) Inj. AMIKACIN 250mg IV / BD
8) Tab PCM 650mg PO / TID
9) Tab LIMCEF PO / OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
DAY 5
1) Inj. METROGYL 750mg IV/TID
2) Inj. PANTOP 40mg IV OD
3) Inj. ZOFER 4mg IV/SOS
4) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. MONOCEF 1gm IV/BD
7) Inj. AMIKACIN 250mg IV/BD
8) Tab PCM 500mg PO/TID
9) Tab LIMCEF PO/OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11)GRBS monitoring 6th hourly regularly.
DAY 6
1)IVF @ 75ml/hr
2) Inj. MONOCEF 1gm IV/BD
3. Inj. AMIKACIN 250mg IV/BD
4) Inj. METROGYL 750mg IV/TID
5) Inj. PANTOP 40mg IV OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
7) Inj. ZOFER 4mg IV/SOS
8) Tab.DOLO 650 mg/PO/SOS
9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
10) Tab LIMCEF PO/OD
11)TEMP CHARTING 4th hourly
DAY 7
1) Inj. MONOCEF 1gm IV/BD
2. Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) TAB.DOLO 650 mg/PO/SOS
10)TAB.ULTRACET 1/2 PO/QID
11) Tab LIMCEF PO / OD
12) BP / PR / TEMP-4 TH HOURLY
DAY 8
1) IVF @ 100 ml / hr
2) Inj. TAZAR 4.15gm
2. Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) TAB.DOLO 650 mg/PO/SOS
10) Tab LIMCEF PO / OD
11)BP / PR / TEMP-4 TH HOURLY
12)INJ.BUSCOPAN IM/SOS IF pain abdomen
DAY 9
1) IVF @ 100 ml / hr
2) Inj. .PAPITAZ 4.5gm IV TID
3) Inj. AMIKACIN 250mg IV/BD
4) Inj. METROGYL 750mg IV/TID
5) Inj. PANTOP 40mg IV OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
7) Inj. ZOFER 4mg IV/SOS
8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
10)TAB.DOLO 650 mg/PO/SOS
11) Tab LIMCEF PO / OD
12)Inj. .BUSCOPAN IM/SOS IF pain abdomen
13)BP / PR / TEMP-4 TH HOURLY
DAY 10
1) Inj. PAPITAZ 4.5gm IV TID
2) Inj. AMIKACIN 250 mg IV BD
3) Inj. METROGYL 750 mg IV TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) INJ.BUSCOPAN IM/SOS IF pain abdomen
10) TAB.DOLO 650 mg/PO/SOS
11) TAB.ULTRACET 1/2 PO/QID
12) BP / PR / TEMP-4 TH HOURLY
13) TEMP CHARTING
DAY 11
1) INJ.PIPTAZ 4.5gm IV TID
2)Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) Inj..BUSCOPAN IM/SOS IF pain abdomen
10) TAB.DOLO 650 mg/PO/SOS
11) TAB.ULTRACET 1/2 PO/QID
12) BP / PR / TEMP-4 TH HOURLY
13)TEMP CHARTING
DAY 12
1) Inj. PIPTAZ 4.5gm IV TID
2) Inj. AMIKACIN 250mg IV/BD
3) Inj. METROGYL 750mg IV/TID
4) Inj. PANTOP 40mg IV OD
5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
6) Inj. ZOFER 4mg IV/SOS
7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
9) INJ.BUSCOPAN IM/SOS IF pain abdomen
10) TAB.DOLO 650 mg/PO/SOS
11) TAB.ULTRACET 1/2 PO/QID
12) BP / PR / TEMP-4 TH HOURLY
13) TEMP CHARTING
DAY 13
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Syp. LACTULOSE 15ml PO/TID
3) Inj. CLAVUM 1.2gm IV/BD
4) SOAP WATER ANEMA
5) Inj. PANTOP 40mg IV OD
6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
7) Inj. ZOFER 4mg IV/SOS
8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
10) INJ.BUSCOPAN IM/SOS IF pain abdomen
11) TAB.DOLO 650 mg/PO/SOS
12) TAB.ULTRACET 1/2 PO/QID
13) BP / PR / TEMP. 4th HOURLY
14) TEMP CHARTING
DAY 14
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.DOLO 650 mg/PO/SOS
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 15
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.DOLO 650 mg/PO/SOS
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 16
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.DOLO 650 mg/PO/SOS
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 17
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
5) Inj. ZOFER 4mg IV/SOS
6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
8) INJ.BUSCOPAN IM/SOS IF pain abdomen
9) TAB.DOLO 650 mg/PO/SOS
10) TAB.ULTRACET 1/2 PO/QID
11) BP / PR / TEMP. 4th HOURLY
12) TEMP CHARTING
DAY 18
1) Inj. MEROPENAM 1gm IV/BD
2) Inj. PANTOP 40mg IV OD
3) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
4) Inj. ZOFER 4mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD
6) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F
7) INJ.BUSCOPAN IM/SOS IF pain abdomen
8) TAB.PCM 500 mg/PO/TID
9) TAB.ULTRACET 1/2 PO/QID
10) BP / PR / TEMP. 4th HOURLY
11) TEMP CHARTING
DAY 19
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. ZOFER 4mg IV/SOS
5) TAB.PCM 500 mg/PO/TID
6) TAB.ULTRACET 1/2 PO/QID
7) BP / PR / TEMP. 4th HOURLY
8) TEMP CHARTING
DAY 20
1) Inj. CEFTAZIDINE 1gm IV/BD
2) Inj. CLAVUM 1.2gm IV/BD
3) Inj. PANTOP 40mg IV OD
4) Inj. ZOFER 4mg IV/SOS
5) TAB.PCM 500 mg/PO/TID
6) TAB.ULTRACET 1/2 PO/QID
7) BP / PR / TEMP. 4th HOURLY
8) TAB ULTRACET 1/2 /PO/QID
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