21 YEARS OLD FEMALE WITH VIRAL PNEUMONIA SECONDARY TO COVID-19

June 11, 2021

"This is an 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 patient's clinical problems with collective current best evidence based inputs".

This E log book also reflects my patient-centered online learning portfolio and your valuable comments on comment box is welcome.

MEDICINE CASE DISCUSSION:

I've been given this case to solve in an attempt to understand the topic of "Patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

VIEW OF THE CASE :

A 21 years old female, student by occupation, hailing from Nalgonda came to OPD with chief complaints of fever since 7 days and shortness of breathe since 3 days, cough, fever, vomitings and motions since 3 days.

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 3 days back

later she developed shortness of breathe since 3 days which is insidious in onset, progressive with Grade I to II, increased on exertion, releived on rest.

There is orthopnoea and No PND

She is tested RAPID ANTIGEN TEST for COVID-19 POSITIVE from the time of admission.

She complains of cough since 3 days with expectoration,mucoid, non foul smelling,

History of fever since 3 days which is insidious in onset, continuous, high grade associated with chills and rigor.

History of vomitings since 3 days.

History of passing loose stoolssince 3 days(5-6 episodes per day)

There is decreased urine output since 3 days.

No history of chest pain, wheeze, hemoptysis, loss of weight

PAST HISTORY:

She is a known case of HYPERTENSION since 1 year

Abdominal distension since 6 months.

She got an attack of epilepsy 2 months back

No history of Diabetes, CAD, Asthma, Tuberculosis

TREATMENT HISTORY:

She has been taking medications TAB. NICARDIA 10mg and ARTAMINE 40 mg for hypertension since 1 year

History of kidney biopsy in 2016

She was on dialysis treatment since 1 year(every 15 days for 6 months and every alternate day since past 6 months)

PERSONAL HISTORY:

Appetite- loss of appetite

Diet- mixed

Bowel habits- passing loose stools

Bladder habits- decreased urine output

Sleep- adequate

Addictions- no addictions

Allergies- no allergies

FAMILY HISTORY:

Insignificant

GENERAL EXAMINATION:

Conscious, coherent and cooperative

Well oriented to time, place and person

Moderately built and moderately nourished

Pallor- PALLOR PRESENT

Icterus- No icterus

Cyanosis- No Cyanosis

Clubbing- No clubbing

Generalised lymphadenopathy- No generalised lymphadenopathy

Pedal edema- BILATERAL PEDAL EDEMA

Malnutrition- No

Dehydration- No

VITALS:

Temperature - 98.9°F

Pulse rate- 90 bpm

Respiratory Rate- 30 cycles per minute

Blood Pressure- 120/80 mm of Hg

SpO2- 85% at room air

GRBS- 172 mg%

Vitals recorded :

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM- S1 and S2 heart sounds heard, no murmers

RESPIRATORY SYSTEM- Bilateral air entry present with vesicular breath sounds and no added sounds

CENTRAL NERVOUS SYSTEM- intact

ABDOMEN- no organomegaly

INVESTIGATIONS:

LFT:

Total bilirubin : 2.14 mg/dl

Direct Bilirubin: 0.81 mg/dl

Alkaline phosphate: 154 IU/L

Total Proteins: 5.2gm/dl

Albumin : 2.7gm/dl

CBP :

Hemoglobin : 6.6gm/dl

Neutrophils: 82%

Lymphocytes: 13%

RFT:

Urea: 129 mg/dl

Creatinine: 7.3 mg/dl

ECG-

DIAGNOSIS:

CKD ON MAINTENANCE HEMO DIALYSIS WITH HYPERTENSION WITH COVID-19 POSITIVE

TREATMENT :

INJ. AUGMENTIN 25mg IV BD
INJ. METROGYL 400mg TID/PO
INJ. PAN 40mg IV OD
INJ. ERYTHROPOIETIN 4000IU S/C TWICE WEEKLY
TAB. NODOSIS 500mg BD
TAB. ZOFER 4mg BD
TAB. SPOROLAC TID
SYP. ASCORIL 2 TSP TID
TEPID SPONGING
TAB. PCM 650mg (SOS)
O2 INHALATION WITH FACEMASK at 4L/MIN
INJ. LASIX 40mg BD
MONITOR VITALS
GRBS MONITORING 6TH HOURLY
TAB. BUSCOPAN SOS
INJ. LEVOFLOX 500mg IV/OD

ONE BLOOD TRANSFUSION IS DONE I/V/O SEVERE ANEMIA DURING HEMODIALYSIS

Patient died on 3rd day of hospitalization at 2:21pm.

DEATH SUMMARY:

Patient is a known case of CKD and is on MAINTENANCE HEMODIALYSIS since 1 year. Patient was complaining of shortness of breathe, cough, fever, vomitings and loose stools since 3 days. From the time of admission RAPID ANTIGEN for COVID-19 was POSITIVE. Patient was placed on appropriate antibiotics, O2 Inhalations, Nebulization and one blood transfusion was done I/V/O SEVERE ANEMIA during hemodialysis. Patient started complaining of SEVERE SHORTNESS OF BREATHE and is not releived with nebulization. Patient had SUDDEN CARDIAC ARREST on 03.05.2021 at 1:40pm. Pulse was absent and not responsive. Immediate intubation and CPR was started according to 2015 AHA guidelines. Inspite of our efforts, patient couldn't be revived and declared dead at 2:21pm on 03.05.2021 after confirming no electrical activity on ECG(flat line).

Immediate cause: SUDDEN CARDIAC ARREST

Antecedent cause: CKD ON MHD WITH VIRAL PNEUMONIA SECONDARY TO COVID-19

CPR: