typhoid case and the investigations done and treatment given

1. BY,
M.Logeshwary

2. A three and half year old female child patient was
admitted in hospital on 26/10/2016
Chief complaints:
c/o fever for 1 week,high grade and intermittent
c/o headache ,myalgia
c/o cold/cough and sore throat for 4 weeks
c/o vomitting for 4 days soon after feeds
c/o loose stools for 2 days not blood stained
c/o abdominal pain
c/o chills/rigors
c/o fatigue

3. History of present illness
 No h/o of jaundice/seizures/skin rashes/bleeding
manifestations
 No h/o dysuria

4. Past medical history:
Nil
Past medication history:
Nil
Personal histoy:
 Birth h/o:LSCS , BW:2.75 kg
 Developmentally normal
 Immunised upto age

5. Physical examination
 Patient is concious
 No pallor
 No cyanosis
 No clubbing
 No edema
 No icterus

6. On examination:
Temp: 100.3 F
RR: 14 cycles/min
HR: 88 beats/min
Systemic examination:
CVS: S1S2 +
RS : NVBS
CNS : NFND
P/A : soft

7. PARAMETERS OBSERVED VALUES NORMAL VALUES
Hb 9.8 g/dl 11-13 g/dl
Neutrophills 60% 23-54%
Lymphocytes 38% 35-65%
Eosinophills 2 % 1-6%
Platelet 2.1 lakhs /mcl 1.5-4.5 lakhs/mcl
Total count 11200cells /mm 4000-11000cells/mm
Lab investigations

8. Other test:
 Blood widal test
 Chest X-ray
Impression:
 Widal test – 1:160 dilutions positive
 Chest X ray normal
Diagnosis:
TYPHOID FEVER

9. DRUGS DOSE R.O.A FREQ DURATION
IVF isolytic fluid 40ml/hr IV 0-24 hrs  
ORS(Oral Rehydration
Solution)
Sachet SOS 
Cap.Bifilac Sachet p/o Bd  
Syp.Zinc 5ml p/o Od  
Inj.Emeset(ondansetron) 1cc IV Bd  
Inj.Rantac(ranitidine) 1cc IV Bd/Od  
T.Para(acetaminophen) 500mg p/o ½ qid / sos  
Inj.Taxim(cefotaxime) 20mg/ml IV Bd  
Syp.Waltuz Br(ambroxal
combination)
3.5ml p/o Bd  
DMO REVIEW :
T.Ambronac(ambroxal
combination)
200mg p/o Bd  
DRUG CHART

10. Medication error:
Nil
Drug interaction:
Nil
Discharge advice:
The patient is continuing the treatment and
is advised to strictly adhere to the drug regimen.
Patient counselling:
The patient is advised to take light diet
foods , take rest , keep the hands clean , also maintain
the environment around the child clean and also
consume clean water. Continue the drug regimen.

11. SOAP NOTES
 Subjective:
A three and half year old female child was
admitted in hospital with chief complaints of fever for
1 week , high grade and intermittent , headache ,
myalgia , cold/cough and sore throat for 4 weeks ,
vomiting for 4 days soon after feeds, loose stools for 2
days not blood stained , abdominal pain ,chills/rigors ,
fatiguability.

12.  Objective:
Hb level is low in this patient. Neutrophills and total count
is increased. Widal test and chest X ray is also taken in this
patient since this patient has high grade of cough , cold and fever
 Assesment:
On assessing the patients lab investigations of low Hb
levels the patient is very weak, and as the total count and
neutrophills are increased the patient should have suffering from
any sort of infections. Widal test shows positive on 1:160
dilutions , so the patient is diagnosed to have TYPHOID FEVER,
and chest ray seems to be normal for this patient

13. Plan of treatment:
 IVF isolytic fluid and ORS powder is given as this patient is
suffering from heavy dehydration due to loose stools and
vomiting for past 4 days.
 Bifilac capsule is generally given for GI disorders and diarrhea in
children. It is given for this patient as this patient is suffering
from diarrhea.
 Tablet zinc is given for best uptake of ORS and is also used for
the treatment of diarrhea.
 Injection ondansetron is given as anti-emetic to avoid vomiting.
 Injection ranitidine is given to avoid ulcer, stomach pain and
heart burn. This also give some relief from cold and cough.

14.  Since the patient is suffering from high grade intermittent
fever tablet acetaminophen is given.
 Injection taxim is given as antibiotic for typhoid fever as
this line of cephalosporins act as first line drug in typhoid.
 Syrup waltuz br is ambroxal combination which act as
expectorant and bronchodilator and gives relief on cough ,
chest compression, chest tightness , thickened mucus
cough.
 Since acetaminophen is given for this child continuously
toxicity may occur. To avoid this tablet ambronac is given
which prevents the paracetamol toxicity and it also act as
mucolytic and mucokinetic

15. THANK YOU