A 50 year old female with Viral Pneumonia secondary to Covid-19

Neha Pradeep, MBBS 8th semester

Roll no: 99

This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome .

 

I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan. 

A 50 YEAR OLD FEMALE WITH VIRAL PNEUMONIA SECONDARY TO COVID-19

Following is the view of my case :  (history as per the date of admission) 

Case:

A 50 year old female came to the OPD with chief complaint of fatigue since 2 weeks and fever since 1 week. Patient presented to the hospital with shortness of breath and low oxygen levels.

History of Presenting Illness:

The patient was apparently asymptomatic 2 weeks ago, when she developed fatigue, which was insidious in onset, and gradual in progression with no aggravating factors.

Fever developed 1 week ago and was insidious in onset. It was low grade, continuous type and not associated with chills and rigors. 

No complaint of cough, chest pain, loss of smell or taste. 

Past History:

Medical History: Not a known case of DM, HTN

Surgical History: Hysterectomy- 1 year ago

Personal History:

Diet - Mixed

Appetite - Normal

Sleep - Adequate

Bowel and Bladder movements - Regular

Addictions - None

Family History:

Patient's brother tested positive for Covid-19.

General Examination:

The patient is conscious, coherent and cooperative and well oriented to time place and person. She is sitting comfortably on the bed, moderately built and well nourished .

  Pallor: absent

  Icterus: absent 

  Cyanosis: absent 

  Clubbing: absent 

  Lymphadenopathy: absent

  Edema: absent 

Vitals:

     Temperature: afebrile 

     Blood pressure: 110/70 mm Hg

     SpO2 : 95% on room air

     Pulse: 84 bpm

     

Systemic Examination: 

         • Respiratory system: Normal vesicular breath sounds heard 

        • CVS: S1 and S2 heard 

                No added murmurs

        •PA: Soft and non-tender,

            No organomegaly 

        •Central Nervous System: intact 

INVESTIGATIONS:

    •CBP:    

              Hb:12.2 gm%

              TLC: 8600 cells/mm3

              DLC : Neutrophils: 73

                         Lymphocytes: 19

                         Eosinophils: 04

                         Monocytes: 04

               Platelet count: 2.98 Lakh/cu. mm

    •CRP: positive 

               2.4 mg/dL

   •D-Dimer: 960 ng/ml

  •GRBS: 604 mg/dL

  •HbA1c: 7.9%

  •LFT:

        Total Bilirubin: 0.66 mg/dl

        Direct Bilirubin: 0.18 mg/dl

        SGOT (AST): 21 IU/L

        SGPT (ALT): 14 IU/L

        Alkaline Phosphate: 181 IU/L

        Total Proteins: 6.0 gm/dl

        Albumin: 3.3 gm/dl

        A/G Ratio: 1.20

     • RFT:

        Urea: 60 mg/dl

        Creatinine: 0.8 mg/dl

        Uric Acid: 5.2 mg/dl

        Calcium: 9.6 mg/d;

        Phosphorous: 3.6 mg/dl

        Sodium: 130 mEq/L

        Potassium: 4.4 mEq/L

        Chloride: 95 mEq/L

Provisional Diagnosis:

Viral pneumonia secondary to covid-19 infection and denovo DM.

Treatment History:

On 14th day of symptoms/ Day of Admission

- IVF 20 NS

- Inj. Pan 40

- Tab. Dolo 650g

- Limcee

- Tab. Zincovit

- Nebulization

SpO2: 98% at room air

On 2nd day of admission

- IVF 20 NS

- Inj. Pan 40

- Tab. Dolo 650g

- Limcee

- Tab. Zincovit

- Nebulization

SpO2: 99% with 10 L of O2

On 3rd day of admission

- Tab. Oseltamivir 75 mg

- Inj. HAI

- 6 ml/hr infusion

-Inj. Clexane

- Syr. Cremaffin plus 10 ml

SpO2: 98% with 10L of O2

On 4th, 5th and 6th day of admission

- Inj. HAI

- 6ml/hr infusion

SpO2: 98% with 10L of O2 (4th day)

           95% with 10L of O2 (5th day)

           99% with 10L of O2 (6th day)

On 7th and 8th day of admission

-Inj. HAI

 12-12-12

SpO2: 97% with 10 L of O2 (7th day)

           85% with 15L of O2 (8th day)

On 9th day of admission

- Inj. HAI

 16-16-16

SpO2: 96% with 5L of O2

On 10th day of admission

- Inj. NPH

 10-x-10

-Inj HAI

 8-8-8

SpO2: 96% with 5L of O2

On 11th day of admission

- Inj. NPH

- Tab Glimeperide 1mg 

SpO2: 97% with 2L of O2

On 12th day of admission (Day of Discharge)

- Inj. NPH

- Tab Glimeperide 1mg 

SpO2: 97% with 2L of O2

Overall Treatment Given:

-Oxygen Inhalation to Maintain SpO2 >90%

-IVF NS @75ml/hr

-TAB Dolo 650 mg/po/sos

-TAB MVT /po/od

-TAB Limcee /po/od

-TAB Oseltamavir 75 mg/po/bd

-Inj Clexane 40 mg/sc/od

-Inj HAI 12 U TID

-Syp Cremaffin 30 ml/hs

-Betadine Gargles 4-5 times a day

-Neb Duolin, Budecort 8th hourly

Advice at Discharge:

-Oxygen inhalation to maintain SpO2 >90%

-TAB PAN 40 mg/po/1-0-0 x 1 week

-TAB MVT /po/0-1-0 x 1 week

-TAB DOLO 650 mg/po/sos

-TAB LIMCEE /po/0-1-0 x 1 week

-TAB GLIMI 1 /po/1-0-0 to continue

-Betadine Garglings 4-5 times a day 

Questions: 

1) Since patient didn't show any characteristic DM signs, did the Covid-19 infection aggravate any underlying condition?

2) Did the patient's diabetic condition make them more prone to develop pneumonia?

3) Can D-dimer be a value which can link Covid-19 and Diabetes, due to the increased thromboembolic state? 

Under the guidance of Dr. Vamsi, Dr. Durga Krishna and Dr. Vilasith.