A 28 year old male patient was admitted to the male medicine ward with complaints of fever since 1 week, bodyache, headache, slightly yellowish sclera and watery eyes.
1. A Case Study On Typhoid
Fever
(SOAP)
- Ajita Sadhukhan
- Pharm D. 3rd year
- Roll No. : 1
- Enrolment No. : 150821207001
2. Definition
Typhoid or Enteric Fever is an infectious feverish disease
caused by the bacterium Salmonella typhi (Salmonella
enterica Serovar Typhi ) and less commonly by
Salmonella paratyphi.
Acute generalized infection of the reticulo-endothelial
system, intestinal lymphoid tissue and the gall bladder.
The infection always comes from another human, either
an ill person or a healthy carrier of the bacterium. The
bacterium is passed on with water and foods and can
withstand both drying and refrigeration.
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3. Patient Demographics:
Patient I.P. No.: 17009875
Patient O.P. No.: 17112877
Age: 21 years
Weight: 48 Kg
Sex: Male
Department: Male Medicine Ward
Unit: 1
Date of Admission: 14. 8. 17
Date of Discharge: 21. 8. 17
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4. Reason For Admission: - Fever since 1 week
- body ache
- headache
- sclera slightly yellowish
- watery eyes
Past Medical History: NAD
Past Medication History: Patient had taken medication for fever at home.
Family history: NAD
Social history: student
Previous allergies: none
Pregnancy status: NAD
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8. A 21 year old male patient was admitted to Med. ward-1 with complaints of fever
since 1 week, body ache, headache, sclera slightly yellowish and watery eyes.
Based on lab report, patient’s lymphocytes, ESR and ALT levels are abnormally
increased. Widal Test is Positive. Hence, patient was diagnosed with typhoid fever.
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10. GOALS OF TREATMENT:10
• To reduce fever.
• To reduce body ache.
• To reduce headache.
• To reduce slightly yellowish sclera.
• To reduce watery eyes.
11. DAY 1
Temperature: 99 F
Pulse: 79/min
SPO2: 98%
B.P.: 110/80 mm Hg
R: 17/min
Adv. : CBC, PS for MP, Widal Test, HIV
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12. Medication chart (day 1)
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Inj. Ceftriaxone +
Sulbactam
I.V. 1.5 g in 100 ml
NS
BD To treat typhoid
fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent
acidity
Inj. Ondanstron I.V. 4 mg TDS To prevent
emesis
Inj. NaCl +
(Optineuron)
Calcium
Pantothenate +
Cyanocobalamin +
Folic acid +
Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte +
Calcium and
Vitamin B
complex
supplement
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13. DAY 2
Temperature: 100 F
Pulse: 80/min
SPO2: 98%
B.P.: 110/80 mm Hg
R: 18/min
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14. Medication chart (day 2)
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DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Paracetamol P.O. 500 mg SOS
1-0-1
Analgesic, anti-
pyretic
Inj. Ceftriaxone +
Sulbactam
I.V. 1.5 g in 100 ml
NS
BD To treat typhoid
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 typhoid fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent
acidity
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. NaCl +
(Optineuron)
Calcium
Pantothenate +
Cyanocobalamin +
Folic acid +
Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte +
Calcium and
Vitamin B
complex
supplement
15. DAY 3
Temperature: 98 F
Pulse: 82/min
SPO2: 98%
B.P.: 120/80 mm Hg
R: 20/min
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16. Medication chart (day 3)
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Diclofenac +
Paracetamol
P.O. 50 mg SOS
1-0-1
Painkiller, anti-
pyretic
Inj. Ceftriaxone +
Sulbactam
I.V. 1.5 g in 100 ml NS BD To treat typhoid
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 typhoid fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent acidity
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. NaCl + (Optineuron)
Calcium Pantothenate +
Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte +
Calcium and
Vitamin B complex
supplement
Syp. Cyprohaptadine +
Tricholine + Sorbitol
P.O 1 tsf 1-0-1 For allergic
reactions
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25. Non-pharmacological treatment:
Some common home remedies
Mash a ripe banana along with 1 tablespoon honey and eat twice a day for a few
days.
Activity
No specific limitations on activity are indicated.
Rest is helpful, but mobility should be maintained if tolerable.
The patient should be encouraged to stay home from work until recovery.
Diet
Fluids and electrolytes should be monitored and replaced diligently.
Oral nutrition with a soft digestible diet is preferable in the absence of abdominal
distension or ileus.
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27. INTERVENTION/POINTS TO BE
COMMUNICATED WITH DOCTOR
SERIOUS → USE ALTERNATIVE
Azithromycin + Ondansetron: Both increase QT interval on prolonged use. Avoid or
use alternative drug.
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29. About Disease:
It is a curable disease.
Two main typhoid fever prevention strategies:
1. Vaccination
✓ Be vaccinated against typhoid while traveling to a country where typhoid is
common.
✓ Need to complete your vaccination at least one week before travel.
✓ Typhoid vaccines lose their effectiveness after several years so check with your
doctor to see if it is time for a booster vaccination.
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30. 2. Avoid risky food and drinks
✓ Buy bottled drinking water or bring it to a rolling boil for one minute before drinking it.
✓ Ask for drinks without ice, unless the ice is made from bottled or boiled water. Avoid
Popsicles and flavored ices.
✓ Eat food that have been thoroughly cooked and that are still hot and steaming.
✓ Avoid raw vegetables and food that cannot be peeled like lettuce.
✓ When eat raw fruit and vegetables that can be peeled, peel yourself. Don’t eat the
peelings.
✓ Avoid foods and beverages from street vendors.
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31. About Medications:
Dose of drugs
Frequency of dose
Route of administrations such as I.V, I.M., t/d, s/c, P.O., S/L.
Counselling regarding overdose (may cause toxicity), underdose
(submaximal or no response) and missing of dose of medication. E.G. If a
dose is missed, then the patient is to be advised to go for the next dose,
otherwise toxicity of drug may occur.
Contraindications
Drug interactions (drug-drug, drug-food)
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32. Life Style Modifications:
SANITORY MEASURES:
Sanitary disposal of human faeces and maintain fly-proof latrines.
Provision of safe chlorinated water and avoid possible back-flow connections between water and
sewer systems.
Educate the community regarding the importance of hand washing especially after defecating.
Control of flies by screening, spraying with insecticides, and use of insecticidal baits and traps.
Control fly breeding by frequent collection and disposal of garbage, and fly-control measures in
latrine construction and maintenance.
Use scrupulous cleanliness in food preparation and handling; refrigerate as appropriate. Particular
attention should be directed to the proper storage of salads and other foods served cold. These
provisions apply equally to home and public eating places.
If uncertain about sanitary practices, select foods that are cooked and served hot, and fruits peeled
by the consumer.
Pasteurize or boil all milk and dairy products. Supervise the sanitary aspects of commercial milk
production, storage and delivery.
Enforce suitable quality-control procedures in industries that prepare food and drink for human
consumption.
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33. FOOD SAFETY:
Contaminated food is another important vehicle for typhoid fever transmission.
Appropriate food handling and processing is paramount and the following basic hygiene measures must be
implemented or reinforced during epidemics:
Washing hands with soap before preparing or eating food;
Avoiding raw food, shellfish, ice; eating only cooked and still hot food or re-heating it.
NATURAL REMEDIES:
Complete bed rest is essential.
Patient should be kept on a liquid diet of orange, barley juice and milk.
Orange juice especially hastens recovery as it increases energy, promotes body resistance and increases
urinary output.
Administer warm water enema regularly.
Apply cold compress to head if temperature rises above 1030F
Wrap the body and legs twice with a sheet wrung in cold water and then cover it with a warm material.
The pack should be kept for an hour and renewed after every 3 hours.
Hot water bottles may be applied to the sides of the body and feet.
Fresh fruits and easily digestible foods can be given after temperature comes down to normal.
Plain water or unsweetened lemon water can be used for drinking.
Gradually start a well-balanced diet.
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