The document describes a 56-year-old male patient admitted with 8 days of high fever. Physical examination found the patient unconscious. Laboratory tests found Herpes Simplex Virus in the CSF. The diagnosis was viral meningitis. The treatment plan includes antiviral medication (Acyclovir) and supportive care, with monitoring of vital signs and symptoms over multiple days showing improvement.

1. BY:
CHETAN

2. SUBJECTIVE
NAME : Mr.ARUN AGE : 56yrs
SEX : M HEIGHT : 160cm
WEIGHT : 60 Kg BMI : 23.4 Kg/m2
REASON FOR ADMISSION :
C/O Fever since 8 days. High grade fever not associated
with chills
PAST MEDICAL HISTORY :
H/O Vomiting and urinary incontinence

3. PHYSICAL EXAMINATION :
Patient was unconscious , moderately built
VITAL SIGNS :
DATE 15/10/16 16/10/16 17/10/16 18/10/16 19/10/16 20/10/16
TEMP 100.6˚F 100˚F 100˚F 99.8˚F 99.5˚F 99˚F
BP 130/80mm
Hg
130/80mm
Hg
120/80mm
Hg
130/80mm
Hg
120/80mm
Hg
120/80mm
Hg
PULSE 82bpm 82bpm 63bpm 62bpm 64bpm 66bpm

4.  LAB INVESTIGATIONS :
 DIFFERENTIAL LEUKOCYTE COUNT:
a. POLYMORPHS : 70% [ 40-60% ]
b. LYMPHOCYTES : 100% [ 20-30% ]
c. BASOPHILS : 0% [ 0-1% ]
d. EOSINOPHILS : 2% [ 1-4% ]
e. MONOCYTES : 1% [ 1-2% ]
 ESR : 20mm/hr [ 0 – 22 mm/hr ]
 HAEMOGLOBIN : 12.8 g/dl [ 12 – 14 g/dl ]
 LUMBAR PUNCTURE :
CSF – Protein : 150 mg/dl [ 8 – 43 mg/dl ]
CSF – Chloride : 116 mg/dl [ 123 – 135 mg/dl ]
CSF – ADA : 8.7 U/L
 CULTURE TEST :
Organism isolated : Herpes Simplex Virus [ HSV ]

5. ELECCTROLYTES :
1.Sodium : 136 mEq/l [130 – 150 mEq/l ]
2. Potassium : 4.1 mEq/l [ 2.5 – 5.8 mEq/l ]
3.Chloride : 104 mEq/l [ 98 – 100 mEq/l ]
LIVER FUNCTION TEST :
1.Total bilirubin : 0.5 mg% [ <1 mg% ]
2.Alkaline phosphatase : 115 U/L [ 84 – 306 U/L ]
3. SGPT : 36 U/L [ 5 – 37 U/L ]

6. DIAGNOSIS :
VIRAL MENINGITIS

7. PLAN
BRAND
NAME
GENERIC
NAME
DOS
E
FRE
Q
DAYS OF TREATMENT
Inj.Dexona Dexametha
sone
4mg 1-1-1 * * * * * * *
Inj.Eptoin Phenytoin 100m
g
1-1-1 * * * * * * * * * * * * * *
Inj.Pantop Pantoprazo
le
40m
g
1-0-0 * * * * * *
Inj.Emeset Ondanset-
ron
4mg 1-1-1 * * * * *
T.R-Cinex INH+RIF 300/
450
mg
1-0-0 * * * * * *
T.Combutol Ethambut-
ol
800
mg
1-0-0 * * * * * *
T.Pyzina Pyrazinami
de
1000
mg
1-0-0 * * * * * *
1 2 3 4 5 6 7 8 9 10 11 12 13

8. T.Benadon Pyridoxine
hydrochlori
de
40
mg
1-0-
0
* * * * * *
T.Dolo Paracetamol 650
mg
SOS * * * * * *
Inj.Acivir Acyclovir 500
mg
TID * * * * * * * *
T.Pantop Pantoprazol
e
40
mg
1-0-0 * * * * * * * *

9. DRUG INTERACTIONS
 RIF + Pyrazinamide
Either increases toxicity of the other by p’codynamic synergism.
 INH + Ondansetron
INH will increase the level or effect of Ondansetron
 RIF + Ondansetron
RIF will decrease the level or effect of Ondansetron
 RIF + Phenytoin
RIF will decrease the level or effect of Phenytoin

10.  Fever reduced
 Vomiting reduced