A CASE OF HEPATIC ABSCESS PRESENTED IN SUMMER 2021

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A 60 years old female presented in the casualty with complaints of chill associated fever and abdominal pain.

CHIEF COMPLAINTs

➤Fever for the past 6 days.

➤Decreased appetite for the past 6 days.

➤Pain abdomen for the past 3 days. 

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 6 days ago after which she developed high grade fever associated with chills, but not associated with cold, cough and burning micturition.

6 days before patient developed decrease in appetite which was not associated with nausea,vomiting,diarrhoea,constipation and weight loss.

Pain abdomen which is diffused, radiating and pricking type which gets aggravated on right lateral position and patient gets relieved in sitting posture.

Patient visited nearby hospital in the view of above complaints.

USG Abdomen was done there.

IMPRESSION :- Mild hepatomegaly with multiple abscess .

HISTORY OF PAST ILLNESS 

➤Not a known case of hypertension,diabetes,bronchial asthma,epilepsy.

➤k/c/o tuberculosis

DRUG HISTORY

➤No significant drug history.

 

PERSONAL HISTORY

➤Occupation: Daily waged labor working in Cotton fields.

➤Patient is married

➤Patient takes mixed diet but has a decreased appetite.

➤Bowel and bladder movement is normal and regular.

alcohol intake

FAMILY HISTORY 

➤No significant family history.

ALLERGIC HISTORY

➤No significant allergic history

GENERAL EXAMINATION 

➤Pallor : Not seen

➤Icterus :  Not seen

➤Cyanosis :  Not seen

➤Clubbing :  Not seen

➤Lymphadenopathy :  Not seen

➤Edema :  Not seen

VITALS

➤Temperature : 1013℉

➤PR : 120 beats per minute

➤BP : 100/70 mmHg

➤RR : 24 cycles per minute

➤SpO2 : 95% in room air

➤Blood Sugar (random) : 100mg/dl

SYSTEMIC EXAMINATION

CARDIOVASCULAR SYSTEM EXAMINATION

➤s1 and s2 heard

➤Thrills absent.,

➤No cardiac   murmurs

 RESPIRATORY SYSTEM

➤Normal vesicular breath sounds heard.

 ➤Bilateral air entry present

ABDOMINAL EXAMINATION

INSPECTION

➤Shape - Scaphoid

➤Umbilicus  - Inverted

➤Equal movements in all the quadrants.

➤No visible pulsation, dilated veins and localized swellings.

PALPATION

➤Local rise of temperature in right hypochondrium.

➤Tenderness in epigastrium and right hypochondrium.

➤Guarding and rigidity in epigastrium and right hypochondrium.

➤Mild enlargement of liver.

PERCUSSION

➤Fluid thrill and shifting dullness absent 

 AUSCULTATION

➤Auscultatory findings are normal.

 

CENTRAL NERVOUS SYSTEM EXAMINATION

➤Conscious and coherent

PROVISIONAL DIAGNOSIS :  MULTIPLE LIVER ABSCESS

INVESTIGATIONS : 

DAY 1

                                                 USG ABDOMEN

USG REPORT
IMPRESSION-Multiple liver abscess
raised echogenicity of bilateral kidney


CT SCAN





DAY 2

➤Serum electrolytes are mildly reduced.

➤SERUM CREATININE IS NORMAL

➤BLOOD UREA IS NORMAL

➤COMPLETE URINE EXAMINATION

APTT TEST:NORMAL

➤Prothrombin time is normal.

CBC-REDUCED HB-9.7gm/dl
TOTATL COUNT-13,900cells/cmm

LYPMHPOCYTES-09%

➤BACTERIAL CULTURE REPORT IS NORMAL

LFT(ELEVATED LEVELS)
TOTAL BILIRUBIN-2.45mg/dl
DIRECT BILIRUBIN-1.89mg/dl
ALBUMIN-2.5gm/dl

DAY 3

➤ESR LEVEL IS HIGHLY ELEVATED - 110mm/1st hour

LIVER ABSCESS

DAY 4

REDUCED LEVEL OF ELECTROLYTE

DAY 6

REVIEW USG-45-55% LIQUEFACTION

DAY 7

XRAY CHEST-POST TB CHANGES

DAY 10

ABDOMEN XRAY

TOTAL COUNT-13300cells/cmm

ESR HIGHLY ELEVATED-120mm/1st hour

DAY 11

REVIEW USG-MULTIPLE LIVER ABSCESS
LIQUEFACTION RANGING FROM 45-55%

DAY 14

COLOUR DOPPLER 2D ECHO

TPR CHART

MANAGEMENT FOR HEPATIC ABSCESS

DAY 1

1) IV fluids -NS,RL,DNS @ 75 ml per hour

2) Inj. METROGYL 750 mg IV / TID

3) Inj. PANTOP 40 mg IV OD

4) Inj. ZOFER 4 mg IV/SOS

5) Inj. TRAMADOL 1 AMP in 100 ml NS slow IV /OD

6) Inj. OPTINEURON 1 AMP in 100 ml NS IV/OD

7) Tab. PARACETAMOL 650 mg PO/TID

8) BP / pulse rate / Body temperature monitoring 4th hourly regularly

9) GRBS monitoring 6th hourly regularly

10) Inj. MONOCEF 1gm IV/BD

11) Inj. AMIKACIN    250 mg IV/BD

DAY 2

1) Iv fluids -NS,RL,DNS @ 75ml per hour

2) Inj. METROGYL 750 mg IV / TID

3) Inj. PANTOP 40mg IV / OD

4) Inj. ZOFER 4mg IV/SOS

5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD

7) Inj. MONOCEF 1gm IV / BD

8) Inj. AMIKACIN 250mg IV / BD

9) Tab PCM 650mg PO / TID

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11) GRBS monitoring 6th hourly regularly.

DAY 3

1) Inj. METROGYL 750mg IV/TID

2) Inj. PANTOP 40mg IV OD

3) Inj. ZOFER 4mg IV/SOS

4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD

6) Inj. MONOCEF 1gm IV / BD

7) Inj. AMIKACIN 250mg IV / BD

8) Tab PCM 650mg PO/TID

9) Tab LIMCEF PO / OD

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11) GRBS monitoring 6th hourly regularly.

DAY 4

1) Inj. METROGYL 750mg IV / TID

2) Inj. PANTOP 40mg IV OD

3) Inj. ZOFER 4mg IV/SOS

4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD

6) Inj. MONOCEF 1gm IV / BD

7) Inj. AMIKACIN 250mg IV / BD

8) Tab PCM 650mg PO / TID

9) Tab LIMCEF PO / OD

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11) GRBS monitoring 6th hourly regularly.

DAY 5

1) Inj. METROGYL 750mg IV/TID

2) Inj. PANTOP 40mg IV OD

3) Inj. ZOFER 4mg IV/SOS

4) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. MONOCEF 1gm IV/BD

7) Inj. AMIKACIN 250mg IV/BD

8) Tab PCM 500mg PO/TID

9) Tab LIMCEF PO/OD

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11)GRBS monitoring 6th hourly regularly.

DAY 6

1)IVF @ 75ml/hr

2) Inj. MONOCEF 1gm IV/BD

3. Inj. AMIKACIN 250mg IV/BD

4) Inj. METROGYL 750mg IV/TID

5) Inj. PANTOP 40mg IV OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

7) Inj. ZOFER 4mg IV/SOS

8) Tab. DOLO 650 mg/PO/SOS

9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

10) Tab LIMCEF PO/OD

11)TEMP CHARTING 4th hourly

DAY 7

1) Inj. MONOCEF 1gm IV/BD

2. Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) TAB.DOLO 650 mg/PO/SOS

10)TAB.ULTRACET 1/2 PO/QID

11) Tab LIMCEF PO / OD

12) BP / PR / TEMP-4 TH HOURLY

DAY 8

1) IVF @ 100 ml / hr

2) Inj. TAZAR 4.15gm

2. Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) TAB.DOLO 650 mg/PO/SOS

10) Tab LIMCEE PO / OD

11)BP / PR / TEMP-4 TH HOURLY

12)INJ.BUSCOPAN IM/SOS IF pain abdomen

DAY 9

1) IVF @ 100 ml / hr

2) Inj. .PIPTAZ 4.5gm IV TID

3) Inj. AMIKACIN 250mg IV/BD

4) Inj. METROGYL 750mg IV/TID

5) Inj. PANTOP 40mg IV OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

7) Inj. ZOFER 4mg IV/SOS

8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

10)TAB.DOLO 650 mg/PO/SOS

11) Tab LIMCEF PO / OD

12)Inj. .BUSCOPAN IM/SOS IF pain abdomen

13)BP / PR / TEMP-4 TH HOURLY

DAY 10

1) Inj. PIPTAZ 4.5gm IV TID

2) Inj. AMIKACIN 250 mg IV BD

3) Inj. METROGYL 750 mg IV TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) INJ.BUSCOPAN IM/SOS IF pain abdomen

10) TAB.DOLO 650 mg/PO/SOS

11) TAB.ULTRACET 1/2 PO/QID

12) BP / PR / TEMP-4 TH HOURLY

13) TEMP CHARTING

DAY 11

1) INJ.PIPTAZ 4.5gm IV TID

2)Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) Inj..BUSCOPAN IM/SOS IF pain abdomen

10) TAB.DOLO 650 mg/PO/SOS

11) TAB.ULTRACET 1/2 PO/QID

12) BP / PR / TEMP-4 TH HOURLY

13)TEMP CHARTING

DAY 12

1) Inj. PIPTAZ 4.5gm IV TID

2) Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) INJ.BUSCOPAN IM/SOS IF pain abdomen

10) TAB.DOLO 650 mg/PO/SOS

11) TAB.ULTRACET 1/2 PO/QID

12) BP / PR / TEMP-4 TH HOURLY

13) TEMP CHARTING

DAY 13

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Syp. LACTULOSE 15ml PO/TID

3) Inj. CLAVUM 1.2gm IV/BD

4) SOAP WATER ANEMA

5) Inj. PANTOP 40mg IV OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

7) Inj. ZOFER 4mg IV/SOS

8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

10) INJ.BUSCOPAN IM/SOS IF pain abdomen

11) TAB.DOLO 650 mg/PO/SOS

12) TAB.ULTRACET 1/2 PO/QID

13) BP / PR / TEMP. 4th HOURLY

14) TEMP CHARTING

DAY 14

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.DOLO 650 mg/PO/SOS

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 15

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.DOLO 650 mg/PO/SOS

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 16

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.PCM 500 mg/PO/TID

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 17

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.PCM 500 mg/PO/TID

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 18

1) Inj. MEROPENAM 1gm IV/BD

2) Inj. PANTOP 40mg IV OD

3) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

4) Inj. ZOFER 4mg IV/SOS

5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

6) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

7) INJ.BUSCOPAN IM/SOS IF pain abdomen

8) TAB.PCM 500 mg/PO/TID

9) TAB.ULTRACET 1/2 PO/QID

10) BP / PR / TEMP. 4th HOURLY

11) TEMP CHARTING

DAY 19

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. ZOFER 4mg IV/SOS

5) TAB.PCM 500 mg/PO/TID

6) TAB.ULTRACET 1/2 PO/QID

7) BP / PR / TEMP. 4th HOURLY

8) TEMP CHARTING

DAY 20

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. ZOFER 4mg IV/SOS

5) TAB.PCM 500 mg/PO/TID

6) TAB.ULTRACET 1/2 PO/QID

7) BP / PR / TEMP. 4th HOURLY

8) TEMP CHARTING

DISCHARGE SUMMARY

>PATIENT GOT DISCHARGED ON DAY 20 WITH ADVISE FOR FOLLOW UP AFTER 15 DAYS.

CHIEF COMPLAINTs

➤Fever for the past 6 days.

➤Decreased appetite for the past 6 days.

➤Pain abdomen for the past 3 days. 

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 6 days ago after which she developed high grade fever associated with chills, but not associated with cold, cough and burning micturition.

6 days before patient developed decrease in appetite which was not associated with nausea,vomiting,diarrhoea,constipation and weight loss.

Pain abdomen which is diffused, radiating and pricking type which gets aggravated on right lateral position and patient gets relieved in sitting posture.

Patient visited nearby hospital in the view of above complaints.

USG Abdomen was done there.

IMPRESSION :- Mild hepatomegaly with multiple abscess .

HISTORY OF PAST ILLNESS 

➤Not a known case of hypertension,diabetes,bronchial asthma,epilepsy.

➤k/c/o tuberculosis

DRUG HISTORY

➤No significant drug history.

 

PERSONAL HISTORY

➤Patient is married.

➤Patient takes mixed diet but has a decreased appetite.

➤Bowel and bladder movement is normal and regular.

➤Intake of Alcohol 

(180 ml twice a week).

FAMILY HISTORY 

➤No significant family history.

ALLERGIC HISTORY

➤No significant allergic history

GENERAL EXAMINATION 

➤Pallor : Not seen

➤Icterus :  Not seen

➤Cyanosis :  Not seen

➤Clubbing :  Not seen

➤Lymphadenopathy :  Not seen

➤Edema :  Not seen

VITALS

➤Temperature : 101℉

➤PR : 108 beats per minute

➤BP : 100/70 mmHg

➤RR : 24 cycles per minute

➤SpO2 : 95% in room air

➤Blood Sugar (random) : 100mg/dl

SYSTEMIC EXAMINATION 

ABDOMINAL EXAMINATION

INSPECTION

➤Shape - Scaphoid

➤Umbilicus  - Inverted

➤Equal movements in all the quadrants.

➤No visible pulsation, dilated veins and localized swellings.

PALPATION

➤Local rise of temperature in right hypochondrium.

➤Tenderness in epigastrium and right hypochondrium.

➤Guarding and rigidity in epigastrium and right hypochondrium.

➤Mild enlargement of liver.

PERCUSSION

➤Fluid thrill and shifting dullness absent 

 AUSCULTATION

➤Auscultatory findings are normal.

 

CARDIOVASCULAR SYSTEM EXAMINATION

➤s1 and s2 heard

➤Thrills absent.,

➤No cardiac   murmurs

RESPIRATORY SYSTEM

➤Normal vesicular breath sounds heard.

 ➤Bilateral air entry present

CENTRAL NERVOUS SYSTEM EXAMINATION

➤Conscious and coherent

PROVISIONAL DIAGNOSIS :  MULTIPLE LIVER ABSCESS

 COURSE IN HOSPITAL

 

60/F came to our with c/of pain in upper quadrant since 2 days , fever since 1 day and decrease appetite and nausea for past 2 days ,on examination vitals were stable .p/A tenderness and guarding present in right hypochondrium and epigastric region. Routine blood investigations were done, X-ray showed post TB changes and USG showed multiple liver abscess with largest on right side segment 7 with 45-50% liquefaction and patient started on triple antibiotic therapy Inj. MONOCEF 1 gm iv BD, Inj. AMIKACIN 250 mg iv BD , and Inj. METRODINAZOLE 750 mg IV /TID and other symptomatic treatment . A review USG done and USG guided abscess aspiration was done on day 3 . Blood cultures and aspiration cultures turned out to be negative . Sputum for AFB and CBNAAT are negative . As the fever spikes are continued antibiotic escalated to Inj. PIPTAZ 4.5 gm iv TID. Patient 's appetite improved , nausea decreased. Surgery opinion was taken i/v/of pain abdomen and liver abscess suggested antibiotic therapy till liquefaction occurs.

Condition of the patient and recovery was clearly explained to the attenders and advised for discharge and follow up for every 15 days to medicine OPD.

TREATMENT GIVEN FOR HEPATIC ABSCESS

DAY 1

1) IV fluids -NS,RL,DNS @ 75 ml per hour

2) Inj. METROGYL 750 mg IV / TID

3) Inj. PANTOP 40 mg IV OD

4) Inj. ZOFER 4 mg IV/SOS

5) Inj. TRAMADOL 1 AMP in 100 ml NS slow IV /OD

6) Inj. OPTINEURON 1 AMP in 100 ml NS IV/OD

7) Tab. PARACETAMOL 650 mg PO/TID

8) BP / pulse rate / Body temperature monitoring 4th hourly regularly

9) GRBS monitoring 6th hourly regularly

10) Inj. MONOCEF 1gm IV/BD

11) Inj. AMIKACIN    250 mg IV/BD

DAY 2

1) Iv fluids -NS,RL,DNS @ 75ml per hour

2) Inj. METROGYL 750 mg IV / TID

3) Inj. PANTOP 40mg IV / OD

4) Inj. ZOFER 4mg IV/SOS

5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD

7) Inj. MONOCEF 1gm IV / BD

8) Inj. AMIKACIN 250mg IV / BD

9) Tab PCM 650mg PO / TID

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11) GRBS monitoring 6th hourly regularly.

DAY 3

1) Inj. METROGYL 750mg IV/TID

2) Inj. PANTOP 40mg IV OD

3) Inj. ZOFER 4mg IV/SOS

4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD

6) Inj. MONOCEF 1gm IV / BD

7) Inj. AMIKACIN 250mg IV / BD

8) Tab PCM 650mg PO/TID

9) Tab LIMCEF PO / OD

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11) GRBS monitoring 6th hourly regularly.

DAY 4

1) Inj. METROGYL 750mg IV / TID

2) Inj. PANTOP 40mg IV OD

3) Inj. ZOFER 4mg IV/SOS

4) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV / OD

6) Inj. MONOCEF 1gm IV / BD

7) Inj. AMIKACIN 250mg IV / BD

8) Tab PCM 650mg PO / TID

9) Tab LIMCEF PO / OD

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11) GRBS monitoring 6th hourly regularly.

DAY 5

1) Inj. METROGYL 750mg IV/TID

2) Inj. PANTOP 40mg IV OD

3) Inj. ZOFER 4mg IV/SOS

4) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. MONOCEF 1gm IV/BD

7) Inj. AMIKACIN 250mg IV/BD

8) Tab PCM 500mg PO/TID

9) Tab LIMCEF PO/OD

10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.

11)GRBS monitoring 6th hourly regularly.

DAY 6

1)IVF @ 75ml/hr

2) Inj. MONOCEF 1gm IV/BD

3. Inj. AMIKACIN 250mg IV/BD

4) Inj. METROGYL 750mg IV/TID

5) Inj. PANTOP 40mg IV OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

7) Inj. ZOFER 4mg IV/SOS

8) Tab.DOLO 650 mg/PO/SOS

9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

10) Tab LIMCEF PO/OD

11)TEMP CHARTING 4th hourly

DAY 7

1) Inj. MONOCEF 1gm IV/BD

2. Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) TAB.DOLO 650 mg/PO/SOS

10)TAB.ULTRACET 1/2 PO/QID

11) Tab LIMCEF PO / OD

12) BP / PR / TEMP-4 TH HOURLY

DAY 8

1) IVF @ 100 ml / hr

2) Inj. TAZAR 4.15gm

2. Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) TAB.DOLO 650 mg/PO/SOS

10) Tab LIMCEF PO / OD

11)BP / PR / TEMP-4 TH HOURLY

12)INJ.BUSCOPAN IM/SOS IF pain abdomen

DAY 9

1) IVF @ 100 ml / hr

2) Inj. .PAPITAZ 4.5gm IV TID

3) Inj. AMIKACIN 250mg IV/BD

4) Inj. METROGYL 750mg IV/TID

5) Inj. PANTOP 40mg IV OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

7) Inj. ZOFER 4mg IV/SOS

8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

10)TAB.DOLO 650 mg/PO/SOS

11) Tab LIMCEF PO / OD

12)Inj. .BUSCOPAN IM/SOS IF pain abdomen

13)BP / PR / TEMP-4 TH HOURLY

DAY 10

1) Inj. PAPITAZ 4.5gm IV TID

2) Inj. AMIKACIN 250 mg IV BD

3) Inj. METROGYL 750 mg IV TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) INJ.BUSCOPAN IM/SOS IF pain abdomen

10) TAB.DOLO 650 mg/PO/SOS

11) TAB.ULTRACET 1/2 PO/QID

12) BP / PR / TEMP-4 TH HOURLY

13) TEMP CHARTING

DAY 11

1) INJ.PIPTAZ 4.5gm IV TID

2)Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) Inj..BUSCOPAN IM/SOS IF pain abdomen

10) TAB.DOLO 650 mg/PO/SOS

11) TAB.ULTRACET 1/2 PO/QID

12) BP / PR / TEMP-4 TH HOURLY

13)TEMP CHARTING

DAY 12

1) Inj. PIPTAZ 4.5gm IV TID

2) Inj. AMIKACIN 250mg IV/BD

3) Inj. METROGYL 750mg IV/TID

4) Inj. PANTOP 40mg IV OD

5) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

6) Inj. ZOFER 4mg IV/SOS

7) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

8) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

9) INJ.BUSCOPAN IM/SOS IF pain abdomen

10) TAB.DOLO 650 mg/PO/SOS

11) TAB.ULTRACET 1/2 PO/QID

12) BP / PR / TEMP-4 TH HOURLY

13) TEMP CHARTING

DAY 13

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Syp. LACTULOSE 15ml PO/TID

3) Inj. CLAVUM 1.2gm IV/BD

4) SOAP WATER ANEMA

5) Inj. PANTOP 40mg IV OD

6) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

7) Inj. ZOFER 4mg IV/SOS

8) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

9) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

10) INJ.BUSCOPAN IM/SOS IF pain abdomen

11) TAB.DOLO 650 mg/PO/SOS

12) TAB.ULTRACET 1/2 PO/QID

13) BP / PR / TEMP. 4th HOURLY

14) TEMP CHARTING

DAY 14

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.DOLO 650 mg/PO/SOS

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 15

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.DOLO 650 mg/PO/SOS

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 16

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.DOLO 650 mg/PO/SOS

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 17

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

5) Inj. ZOFER 4mg IV/SOS

6) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

7) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

8) INJ.BUSCOPAN IM/SOS IF pain abdomen

9) TAB.DOLO 650 mg/PO/SOS

10) TAB.ULTRACET 1/2 PO/QID

11) BP / PR / TEMP. 4th HOURLY

12) TEMP CHARTING

DAY 18

1) Inj. MEROPENAM 1gm IV/BD

2) Inj. PANTOP 40mg IV OD

3) Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

4) Inj. ZOFER 4mg IV/SOS

5) Inj. TRAMADOL 1 AMP in 100ml NS slow IV / OD

6) Inj. NEOMOL 100ml /IV/SOS IF temp >101°F

7) INJ.BUSCOPAN IM/SOS IF pain abdomen

8) TAB.PCM 500 mg/PO/TID

9) TAB.ULTRACET 1/2 PO/QID

10) BP / PR / TEMP. 4th HOURLY

11) TEMP CHARTING

DAY 19

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. ZOFER 4mg IV/SOS

5) TAB.PCM 500 mg/PO/TID

6) TAB.ULTRACET 1/2 PO/QID

7) BP / PR / TEMP. 4th HOURLY

8) TEMP CHARTING

DAY 20

1) Inj. CEFTAZIDINE 1gm IV/BD

2) Inj. CLAVUM 1.2gm IV/BD

3) Inj. PANTOP 40mg IV OD

4) Inj. ZOFER 4mg IV/SOS

5) TAB.PCM 500 mg/PO/TID

6) TAB.ULTRACET 1/2 PO/QID

7) BP / PR / TEMP. 4th HOURLY

8) TEMP CHARTING

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