14 yr old boy came with c/o fever and pain abdomen

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14 year old boy came with c/o fever , body pains , headache , pain abdomen 

PT was apparently asymptomatic 11 days back then he developed which was insidious in onset , high grade associated with chills and rigors , more during night 

No c/o nausea , vomittings 

C/o fever with headache ( diffuse type of pain )

C/o body pains ( diffuse type ) since 3 days 

C/o pain abdomen since 3 days near umbilical region ( non radiating , not associated with vomittings ) 

No c/o malena , burning micturition , loose stools , sob , palpitations , weight loss 

No h/o rash 

No similar complaints in the past 

Not a k/c/o DM , HTN , epilepsy , tb 

Past h/o 

At 6 months of age h/o pneumonia for which he was hospitalised 

And 5 yrs back circumcision was done for phimosis 

O/e ;

PT is c/c/c 

Pr - 80bpm

BP - 80/60 mmHg 

No PICCKLE

S/e

CVS - S1 S2 +

CNS - no FND

Rs - bae + , NVBS 

P/a - soft 

Investigations on admission 

Cue - 

Colour - pale yellow 

Appearance - clear 

Alb - ++ 

Pus cells - 4 to 5 

Epi cells - 3 to 4 

CBP - 

Hb - 8.3

TC - 2,800

Lymphocytes - 16 

Plt - 80,000

Rft - 

Urea - 23

Creatinine - 0.7

UA - 2.3

Na - 135

K- 4.0

Cl - 106 

Serum iron - 67

Spot urine creatinine  - 121.2

Spot urine protein - 83.6

Ratio - 0.68

USG abdomen - 

Slightly altered echo texture of kidneys 

B/l tiny renal calculi

Course and discussion

Treatment day 1 

IVF DNS and RL @ 50 ml/hr

t.pcm 500mg / po / SOS 

Inj.buscopan IV /stat 

Adequate Orla fluids 

temperature monitoring hourly 

Day 2 

C/o giddiness 

PT is c/c/c

Temp 101.1F

Pr - 86bpm

BP - 70/40mmhg

Investigations 

 Reticulocyte count - 0.6

Ferritin - 1463.9

Esr  - 05 

Lft 

TB - 0.81

Db - 0.32

AST - 85

Alt - 72

ALP - 291

Tp - 3.6

Alb - 1.99

A/g - 1.24 

Ns1 - negative 

Hemogram 

Hb - 9.0

TC - 4,300

Plt - 40,000 cells /cumm

Treatment - 

Same treatment plus inj neomol 100mg /IV /SOS  and inj pantop 40mg /IV /od and inj monocef 1g/IV/BD 

Day 3

C/o weakness , dry cough , pain abdomen , increased frequency of loose stools (4 to 6 episodes )

Pr - 88bpm 

BP - 80/50 mmHg 

Temp - 102.8F 

O/e : lymphnode enlargement + in submandibular region and RT axillary region 

CVS - S1 S2 + 

Rs - decreased breath sounds in Lt axilla and scapular region 

CNS - no fnd 

P/a - tenderness + all over the abdomen 

Investigations 

Urine culture report - no growth 

Review usg abdomen- 

1.mild splenomegaly 

2. Gall bladder wall edema with GB sludge 

3. Moderate ascites 

4. Right intraabdominal testis with normal vascularity 

Impression - bronchopneumonia of b/l lower zones and right middle zone 

Treatment :

Same treatment given plus inj zofer IV / tid plus 

3 eggs whites/day 

ORS sachet in 1 lit of water throughout the day whenever the ot passes the stool

And t.sporolac po/BD 

Day 4 

C/o Dry cough , pain abdomen ( decreased ) , loos stools of 6 episodes ( watery consistency , 

PT is c/c/c 

Pr - 108bpm

BP - 90/40 mmHg 

CVS - S1 S2 + 

CNS - no FND 

P/a - abdominal distention + , bowel sounds +

R/s - RT interscapular inspiratory crepts + 

Temp - 103F 

Investigations 

Lft - TB -0.9 

Db - 0.2

AST - 101

Alt - 35

ALP - 256 

Tp - 4

Alb - 1.87

A/g - 0.88

Hemogram 

Hb - 0.95 

TC - 8200

Plt - 50,000

Treatment 

Same treatment given 

Day 5 

C/o loos stools ( 4 to 6)  episodes , watery consistency , pain abdomen decreased 

Pt is c/c/c 

Temp - 98.1F

BP - 90/60 mmHg 

Pr - 96bpm 

Cvs - s1 S2 + 

P/a - soft , non tender ,bs + 

I / o - 1200/1500ml 

Investigations -

24 hr urinary protein - 268

24 hr urine volume - 850

Sr electrolytes 

Na -134

K -3.5

Cl-106

Day 6

C/o loose stools ( watery consistency ) 10 to 12 episodes 

PT is c/c/c 

Temp - 101.1F 

BP - 90/60 mmHg 

Pr - 90bpm 

CVS - s1 S2 + 

Rs - left crepts + 

P/a - soft , non tender 

I/o - 2500/1200

Treatment - same treatment given 

Diagnosis - pancytopenia with hypoalbuminemia secondary to ? Enteric fever