An 43 Yr old female with erythroderma secondary to drug intake

CHEIF COMPLAINTS :- 

Complaints of itchy skin lesions all over the body since 3 months

HISTORY OF PRESENT ILLNESS :-

Patient was apparently asymptomatic before 3 months ago later developed itchy skin lesions all over the body H/o fever 3 days H/o unknown inj taken 3 months backH/o omnacortel 10 mg tab taken for 10 months H/o facial puffiness since 2 monthsH/o usage of ETODOLAC, MACVESTIN 500No H/o similar complaints in the pastH/o loose stools since 3 daysH/o burning micturition since 3 days

PAST HISTORY :- 

Not a known case of DM,HTN,Epilepsy,TB, CVA, thyroid, fcoronary artery disease.

PERSONAL HISTORY :-

Diet - mixed

Appetite - normal

sleep - adequate

Bowel and Bladder movements - regular

Addictions -nil

DRUG HISTORY : 

No significant drug history

FAMILY HISTORY :-

No significant family history

GENERAL EXAMINATION :-

Patient is conscious , coherent , cooperative

at the time of examination

She is examined in a well lit room, with consent taken.

She is well built and well nourished.

Pallor - absent

Icterus - absent

Cyanosis - absent 

Clubbing - absent

lymphadenopathy - absent

Pedal edema - present 

Vitals :

Temperature - Afebrile

Pulse rate - 82 bpm

Respiratory rate - 21 cpm

Blood pressure - 120/60 mmHg

SpO2 - 99% on Room air

GRBS - 101 mg/dl

SYSTEMIC EXAMINATION :-

CVS :- S1 and S2 heart sounds heard

           NO murmurs and thrills

RESPIRATORY SYSTEM :- Bilateral air entry present position of trachea - central Vesicular breathsounds heard

CNS :- no focal neuroligical deficit

ABDOMEN :- Soft and non tender

            No palpable masses

            Bowel sounds heard 

            No organomegaly

INVESTIGATIONS :-

RFT :-

urea - 124

Creat - 3.3

UA - 6.6

Ca - 8.5

P - 3.7

Na - 136

K - 3.2

Cl - 105

LFT :-

TB - 4.69

DB - 4.6

SGOT - 59

SGPT - 25

AIP - 480

TP - 4.4

albumin - 2.41

A/G - 1.28

CBP :-

Hb - 11.5

TLC - 19000

N - 76

L - 13

E - 01

M - 10

B - 00

PLT - 74000

CUE :-

albumin - nil

Sugar - nil

Pus cells - 2,3

Epithelial cells - 2,3

ULTRASOUND CHEST - impression -

Bilateral moderate pleural effusion with collapse and air bronchograms on the right side

TREATMENT:-

TAB AUGMENTIN 625 mg PO/BD

TAB PAN 40 mg PO/OD/BBF

TAB ANTRAX 25 mg PO/OD/HSTAB 

FOLVITE 5 mg PO/BD

TAB AVIL PO/SOS

TAB SPORLAC DS PO/TID

TAB SHELCAL 500 mg 

PO/BDTAB DOLO 650 mg 

PO/SOSTAB VIT D3 60000 IU WEEKLY ONCETAB 

VENUSIAMAX LOTION L/A 

TIDHALOX LOTION L/A HS

Kmno4 SOAKS

CIPLOX D EAR DROPS 30/Tir

STRICT IO CHARTING

MONITORING VITALS

PROVISIONAL DIAGNOSIS:-

Altered sensorium secondary to alcohol intoxication with hypokalemia

vitals monitoring 2 hrly, BP, PR, TEMP

PROVISIONAL DIAGNOSIS:-

Sepsis with MODS with DIC (resolving) secondary to right lower limb cellulitis with bilateral transudative pleural effusion with hypokalemia