Case report about 40 years old COVID-19 positive diabetic patient:

First visit to doctor: 09/06/2021

Haji Hassan son of Mohammad Rasool 40 years old patient living in Qale-Fateh Ullah Came to Dewanbegi Clinic with chief complain of fever/6days, sore throat, body pain and dyspnea.

Vital sign

Temperature 37.8                                                          Heart rate 85

Respiratory rate 26                                                          Blood pressure 100/70

So2 85%                          Weight 78kg                             Height 182cm

Mr. Haji Hassan has history of diabetes mellitus since few years ago (about 4 year).

In physical examination, patient was alert, mouth was dry, with audible chest crepitation.

Impression diagnosis: suspected covid-19 + DM

Treatment: because patient had come only for oxygen therapy oxygen therapy is started along with continuation of drug he is taking.

2nd visit of doctor: 15/06/2021

Haji Hassan son of Mohammad Rasool 40 years old patient living in Qale-Fateh Ullah Came to Dewanbegi Clinic with chief complain sever dyspnea, drowsy.

Vital sign

Temperature 37.6                                                          Heart rate 114

Respiratory rate 30                                                       Blood pressure 100/60

So2 53%                         

In physical examination patient was in respiratory distress and irritable.

Impression diagnosis: suspected covid-19 + DM

Treatment:

  • O2 therapy 10L/mint
  • Serum. N/S 500 cc
  • Amp. Vit C
  • PCM(Amp. Paracetamol 750mg)
  • Amp.Methyl prednisolone 100mg/ inf.NS 100cc

Because the patient was not in our management set up, he was advised to go to COVID-19 specialized hospital to be admitted, because our services were from 8am to 7pm and patient needed 24hr evaluation.

But due to high number of COVID-19 cases, they were unable to find any bed to be admitted; thus, they requested the clinic administration if we could prepare them 24hr bed facility.

Thus the clinic administration toke decision to admit their patient for 24hr in the clinic.

So, the following treatment have been given to the patient:

  • O2 10L/min
  • Enoxaparin 8000unit BID SC
  • Amp.Methyl prednisolone 100mg BID/inf.NS 100cc
  • Tab.Getryl 2mg OD
  • Tab.Glucophage 500mg BID
  • Amp.Paracetamol 1gr PRN

FOLLOW UP 16/06/2021

Vital sign

Temperature 38.4                                                          Heart rate 113

Respiratory rate 27                                                      Blood pressure 110/70

So2 82%    

Investigation

S.D-Dimer 8991.17 ng/ml

S.FBs 120mg/dl

Lymphocytes count LOW

Medication Order

  • O2 8L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 44mg BID 25% tapered dose after 3 day.
  • Rivaroxoban 20mg OD

FOLLOW UP 17/06/2021

Vital sign

Temperature 38.4                                                          Heart rate 113

Respiratory rate 27                                                      Blood pressure 110/70

So2 82%                         

Medication Order

  • O2 8L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 44mg BID 25% tapered dose after 3 day.
  • Rivaroxoban 20mg OD
  • Tab.furesomide 20mg PRN

FOLLOW UP 19/06/2021

Chief complain cough, dyspnea, dizziness

Vital sign

Temperature 36                                                         Heart rate 63

Respiratory rate 23                                                      Blood pressure 90/60

So2 80%       

Medication Order

  • O2 8L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 33mg BID 25% tapered dose after 3 day.
  • Rivaroxoban 20mg OD
  • Tab.furesomide 20mg PRN

FOLLOW UP 20/06/2021

Patient feel better than yesterday and didn’t have active complain vital sign are as following

Vital sign

Temperature 36                                                         Heart rate 79

Respiratory rate 22                                                      Blood pressure 109/60

So2 90%                         

Medication Order

  • O2 8L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 33mg BID 25% tapered dose after 3 day.
  • Rivaroxoban 20mg OD
  • Tab.furesomide 20mg PRN

FOLLOW UP 21/06/2021

Vital sign

Temperature 36                                                         Heart rate 79

Respiratory rate 22                                                      Blood pressure 109/60

So2 90%                    

Medication Order

  • O2 7L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 33mg BID 25% tapered dose after.
  • Tab.Rivaroxoban 20mg OD
  • Tab.furesomide 20mg PRN

FOLLOW UP 22/06/2021

Vital sign

Temperature 36.2                                                         Heart rate 82

Respiratory rate 20                                                     Blood pressure 90/50

So2 95%               

     Investigation

S.D-Dimer 4338ng/

S.FBs 116mg/dl

CRP.12mg/dl

Medication Order

  • O2 5L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 25mg BID 25% tapered dose after 3 day.
  • Tab.Rivaroxoban 20mg OD
  • Tab.furesomide 20mg PRN

FOLLOW UP 23/06/2021

Vital sign

Temperature 36.2                                                         Heart rate 58

Respiratory rate 22                                               Blood pressure 100/70

So2 96%                    

Medication Order

  • O2 4L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 25mg TID 25% tapered dose after 3 day.
  • Tab. Rivaroxoban 20mg OD
  • Tab.furesomide 20mg PRN

FOLLOW UP 24/06/2021

Vital sign

Temperature 36.2                                                         Heart rate 58

Respiratory rate 23                                               Blood pressure 110/70

So2 96%         

Medication Order

  • O2 4L/min
  • Amp.paracetamol 1gr PRN
  • Vial.Vancomycine 1gr BID/100cc NS/30 mint
  • Vial. Meropenium 1gr BID/1000cc NS
  • Tab. Methyl prednisolone 25mg TID 25% tapered dose after 3 day.
  • Tab. Rivaroxoban 20mg OD
  • Tab.furesomide 20mg PRN

FOLLOW UP 25/06/2021

Today patient wants to be discharged with medication, doctor advised him if he find any danger symptom should go to doctor. Now, the patient is discharged with following medication.

  • O2 2L/min
  • Tab.Rivaroxoban 20mg od for 3days
  • Tab.Moxifloxacine 400mg OD
  • Tab.Osnate D OD
  • Surbex Z OD
  • Tab.Paracetamol 650mg TID

Patient is advised the following investigation.

D-dimer =2519.26ng/ml

CRP=06

FBS=79

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