CASE PRESENTATION ON

PYREXIA UNDER
EVALUATION
By
Pranavi Bandari
18GD1T0019

Pharmd 3rd year.

DEMOGRAPHIC DETAILS:-
A 19 year old male patient was admitted in acute medical care unit with
I.P.no.1604695.

COMPLAINTS:-

The patient complained of

• fever with chills and rigor since 2 days associated with sweating and headache
since 2 days.
HISTORY OF PRESENT ILLNESS:-
The patient was asymptomatic 2 days back, then developed fever with
chills,
associated with sweating and headache, more in evening time, no history
of vomitings, no history of burning micturition.

HISTORY OF PAST ILLNESS:-

The patient had no history of past illness.

HABITS:-
The patient was having a mixed diet, his digestion was normal, appetite
was normal, bowel and bladder movement were normal and his sleep was
disturbed.
FAMILY HISTORY:-

The patient’s family history was found to be nothing significant.

SOCIAL HISTORY:-

The patient’s social history was found to be nothing signifcant.

DAY 1:-
C/O:-
fever with chills and rigor
Associated with sweating more in evenings-2 days
Associated with headache
No H/O of vomitings, abdominal pain
No H/O of burning micturition
O/E:-
No pallor, no icterus
BP – 130/80 mmHg
PR – 90 bpm
Temp - 103°F
Heart – S1S2+
Lungs – BAE+ clear
CNS – NAD
ADV:- CBP, blood for malarial parasite
PROVISIONAL DIAGNOSIS:-
The patient was provisionally
diagnosed to be suffering from “Pyrexia Under Evaluation”.
Rx
1. I.V. Fluids:- a. 1 pint RL (Ringer lactate solution)
b. 1 pint DNS (Dextrose normal saline)
2.Inj.PAN (Pantoprazole) – 40mg I.V. OD
3.Inj.Monocef (Ceftriaxone) - 1g I.V. BD
4.Inj.Paracetamol - 1amp I.M. SOS
5.Tab.Lumerax (Lumefantrine) – 80mg PO BD
 LABORATORY DATA:-
• CBP:
Haemoglobin – 14.4 g% (13.5-17)
RBC count – 4.9 million/cubic mm (4.5-5.5)
MCV – 78.7fl (80-96)
MCH – 27.4pg (27-31)
MCHC – 34.9 g/dl (32-36)
Platelet count – 1.93 lakh/cubicmm (1.4-4)
TLC – 7100cells/cubicmm (4000-11000)
Neutrophils – 74% (30-80%)
Lymphocytes – 20% (20-40%)
Eosinophils – 3% (1-4%)
Monocytes – 3% (2-4%)
Haemoparasites:- negative
Peripheral smear:- normocytic and normochromic
DAY 2:-
C/O:- fever with chills and rigor
Associated with sweating, more in evening time
Associated with headache
No H/O vomitings, abdominal paon
No H/O burning micturition
O/E:
BP – 130/80 mmHg
PR – 90 bpm
Temp - 99°F
Heart – S1S2+
Lungs – BAE+ clear
P/A – soft, non-tender
CNS – NAD
Blood for malarial parasite – negative
Adv: Dengue check
Rx:-
CST along with
1. Cap. Rabesafe (rabeprazole) – 20mg BD
2. Tab. Cepodem (Cefpodoxime) – 100mg BD
3. Tab. Dolo (Paracetamol) – 650mg SOS
PHARMACEUTICAL CARE PLAN:-

SUBJECTIVE EVIDENCES: The patient complained of fever with chills and

rigor since 2 days associated with sweating and headache since 2 days.

OBJECTIVE EVIDENCES: Elevated body temperature.

ASSESSMENT: Pyrexia under evaluation.

PLAN:
GOALS OF TREATMENT:
• To improve symptoms
• To identify and treat the underlying cause
• To educate the patient by counselling
• To improve the health related quality of life.
TREATMENT OPTIONS:-

NON-PHARMACOLOGICAL THERAPY:

•The patient should be kept in a cool room.

•Intake of extra fluids and other fluids like water, diluted fruit juices, etc.
•Sponging should be done.

PHARMACOLOGICAL THERAPY:

•Anti-pyretics:-
Ibuprofen
Acetaminophen
MONITORING PARAMETERS:-

•Pulse rate
•Body temperature
•Complete blood picture
•Signs and symptoms
•Adverse drug reactions.

GOALS ACHIEVED:-

•The patient’s body temperature was brought down by day 2.

•Attempt was made to prevent further complications.
•The patient was educated by counselling.
PATIENT COUNSELLING:-
1. ABOUT DISEASE:
The patient was counselled about the disease by saying him the following:
Pyrexia is one of the most common condition and is characterised by an
elevation of body temperature above the normal range. This increase in set-point
triggers increased muscle tone and chills.
Pyrexia is usually accompanied by sickness behaviour, which consists of
depression, anorexia, sleepiness and inability to concentrate.
2. ABOUT MEDICATION:
The patient was counselled about the medication by saying him the following:
• Inj.PAN – 40 mg (pantoprazole) was prescibed as a prophylaxis for gastric
distress. It was to be taken intravenously and once daily.
Side effects: Nausea, vomiting, diarrhoea, insomnia.
• Inj.Monocef – 1g (Ceftriaxone) was prescribed for any urinary tract and
respiratiory tract infections. It was taken intravenously and once daily.
Side effects: Diarrhoea, leucopenia.
• Inj.Paracetamol was prescribed to treat fever as it acts as analgesic and
antipyretic. It was taken intravenously and whenever required.
Side effects: Nausea, allergic reactions, skin rashes, liver or kidney damage.
• Tab. Lumerax – 80mg (Lumefantrine) was prescribed to treat acute complicated
malaria.It was to be taken twice daily and orally.
Side effects: loss of appetite, vomiting, headache.
• Cap.Rabesafe – 20mg (Rabeprazole) was prescribed as a prophylaxis for acid
reflux disorders. It was to be taken orally and twice daily.
Side effects: Vomiting, diarrhoea, dizziness, fatigue.
• Tab. Cepodem – 100mg (Cefpodoxime) was prescribed to treat any infections. It
was to be taken twice daily and taken orally.
Side effects: Gastro-intestinal disturbances, diarrhoea, nausea, vomiting.
• Tab. Dolo – 650mg (Paracetamol) was prescribed to treat fever . It was to be taken
orally and whenever required.
Side effects: Nausea, allergic reactions, skin rashes.
3. ABOUT LIFESTYLE MODIFICATIONS:-

The patient was counselled about the lifestyle modifications by saying him
the following:
• The patient should be advised to be dressed lightly and stay in a cool room.
• He should be advised to take more amount of fluids or other liquids like water,
diluted fruit juices.
• The patient is asked to move here and there but should not be over active or
over exert himself.
THANK
YOU