A 47F with MCTD

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 Link to the case:

http://02shishirareddy.blogspot.com/2022/10/47-year-old-female-brought-to-casualty.html

Updates on the pt till 11/10/22 are put at one place very beautifully by my friend and colleague Dr.Shishira (intern)


Further updates from 12/10/22 are here -

On 12/10/22-


S: 

Sob improved.


O:

Pt is concious coherent and cooperative

PR-103bpm

RR- 17 cpm

BP- 170/90mmHg

Spo2-100% in RA

Temp- 98 F

GRBS-190


A:  MCTD ? SJOGRENS ? systematic sclerosis with nephrotic syndrome (? diabetes ?Lupus )



P:

Inj. LASIX 120MG/HR IV/BD

Inj. METHYL PREDNISOLONE 1G/IV/OD(DAY-2)

CONTINUE ATT 

TAB .ISONIAZID 300MG PO/OD 

TAB.RIFAMPICIN 450MG PO/OD

TAB.PYRAZINAMIDE 1GPO/OD

TAB ETHAMBUTOL 400MG PO/OD

SYP GRICILLINCTUS 10 ML PO/TID

PROTEIN X POWDER 1 scoop in 100 ml milk BD

INJ. HAI (6U-8U-8U)

INJ. NPH (9U-X-9U)

SYP POTCHLOR 20ML IN 1 GLASS OF

20ML-20ML-20ML 

TAB. TELMA 40 MG PO  OD 

TAB. HCQ 200 PO /OD 

TAB. PREDNISONE 20 MG /BD 

GRBS CHARTING 

(BBF , ABF, BL, AL, BD,AD)


http://02shishirareddy.blogspot.com/2022/10/47-year-old-female-brought-to-casualty.html



On 13/10/22-


S: 

Sob improved.


O:

Pt is concious coherent and cooperative

PR-76bpm(regularly irregular)

RR- 18cpm

BP- 160/100 mmHg

Spo2-98% on RA

Temp- 98 F

GRBS-236mg/dL


A:

Extra pulmonary kochs  with ATT since 2M

MCTD ? SJOGRENS ? systematic sclerosis with nephrotic syndrome (? diabetes ?Lupus )



P:

Inj. LASIX 100MG/HR IV/BD

Inj. METHYL PREDNISOLONE 1G/IV/OD(DAY-3) (stop after this dose)

CONTINUE ATT 

TAB .ISONIAZID 300MG PO/OD 

TAB.RIFAMPICIN 450MG PO/OD

TAB.PYRAZINAMIDE 1GPO/OD

TAB ETHAMBUTOL 400MG PO/OD

SYP GRICILLINCTUS 10 ML PO/TID

PROTEIN X POWDER 1 scoop in 100 ml milk BD

INJ. HAI (6U-8U-10U)

INJ. NPH (9U-X-9U)

SYP POTCHLOR 20ML IN 1 GLASS OF

20ML-20ML-20ML 

TAB. TELMA 40 MG PO  OD 

TAB. HCQ 200 PO /OD 

TAB. PREDNISONE 10 MG /BD 

GRBS CHARTING 

(BBF , ABF, BL, AL, BD,AD)


http://02shishirareddy.blogspot.com/2022/10/47-year-old-female-brought-to-casualty.html



On 14/10/22-


S: 

Sob improved.


O:

Pt is concious coherent and cooperative

PR-92bpm(regularly irregular)

RR- 17cpm

BP- 160/100 mmHg

Spo2-98% on RA

Temp- 98 F

GRBS-231mg/dL

Wt:48 kgs


A:

Extra pulmonary kochs  with ATT since 2M

MCTD ? SJOGRENS ? systematic sclerosis with nephrotic syndrome (? diabetes ?Lupus )



P:

Tab LASIX 160MG PO/BD

CONTINUE ATT 

TAB .ISONIAZID 300MG PO/OD 

TAB.RIFAMPICIN 450MG PO/OD

TAB.PYRAZINAMIDE 1GPO/OD

TAB ETHAMBUTOL 400MG PO/OD

PROTEIN X POWDER 1 scoop in 100 ml milk BD

INJ. HAI (8U-10U-12U)

INJ. NPH (11U-X-11U)

SYP POTCHLOR 20ML IN 1 GLASS OF

20ML-20ML-20ML 

TAB. TELMA 40 MG PO  OD 

Tab .Nifedipine 20 mg /PO/QID

TAB. HCQ 200 PO /OD 

TAB. PREDNISONE 10 MG /BD 

GRBS CHARTING 

(BBF , ABF, BL, AL, BD,AD)


http://02shishirareddy.blogspot.com/2022/10/47-year-old-female-brought-to-casualty.html


On 15/10/22-


S: 

Sob improved.


O:

Pt is concious coherent and cooperative

PR-84 bpm(regularly irregular)

RR- 18cpm

BP- 160/100 mmHg

Spo2-98% on RA

Temp- 98 F

GRBS-94mg/dL

Wt:49kgs


A:

Extra pulmonary kochs  with ATT since 2M

MCTD ? SJOGRENS ? systematic sclerosis with Lupus nephritis 



P:

Tab LASIX 160MG PO/BD

CONTINUE ATT 

TAB .ISONIAZID 300MG PO/OD 

TAB.RIFAMPICIN 450MG PO/OD

TAB.PYRAZINAMIDE 1GPO/OD

TAB ETHAMBUTOL 400MG PO/OD

PROTEIN X POWDER 1 scoop in 100 ml milk BD

Tab.MYCOPHENOLATE MOFETIL 500 mg/BD

INJ. HAI (8U-10U-12U)

INJ. NPH (11U-X-9U)

SYP POTCHLOR 20ML IN 1 GLASS OF

20ML-20ML-20ML 

TAB. TELMA 40 MG PO  OD 

Tab .Nifedipine 20 mg /PO/QID

TAB. HCQ 200mg PO /OD 

TAB. PREDNISOLONE 10 MG /BD 

GRBS CHARTING 

(BBF , ABF, BL, AL, BD,AD)


http://02shishirareddy.blogspot.com/2022/10/47-year-old-female-brought-to-casualty.html


Pt was discharged on 15/10/22






Therapeutic ascitic tap was done (on 12/10/22)and 2ltrs of ascitic fluid was taken out under strict aseptic conditions.Frists of ascitic tap ..procedure video is linked below (thanks to Dr.Venkat Sai sir (pgy1) for guiding me through the procedure)




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