54Y/F With fever spikes....

A 54yr old female was bought to causally complaining of fever since 7 days, initially for the first 2day it was intermittent followed by continuous fever since 5days. fever was associated with chills 

generalized body pains along with fever including low back ache 

c/o mouth ulcers from past 3days 

no h/o renal calculus prior to this episode. 

h/o using NSAIDS for body aches since the last 10yrs 

K/c/o HTM since 7yrs on medication(telmesartan 40mg + amlodepine5mg) and DM since 6yrs on medication (voglibose+gliclazide+Metformin)

not a k/c/o TB, BA, Thyroid disorders, CVA 

Personal history- 

She is married and a homemaker

appetite- normal 

mixed diet

Burning micturition

bowel movements are regular 

she does not consume alcohol, cigarettes or illicit drugs

no significant family history

o/e

temp- 104.3 F 

pr- 102bpm

BP- 110/80

RR 20

SPO2- 87 @ Room air

GRBS- 286mg%

Pallor present

B/L pedal edema (grade 2)

no icterus, cyanisis, clubbing, lyphadenopathy 

CVS- S1 S2 

RS- BAE, NVBS 

PA- abd- obese, Soft non tender 

CNS- conscious

normal speech

cranial nerves, motor, senslry system- NAD 

GCS- 15/15

provisional diagnosis- AKI, urosepsis, old CAD

laboratory investigations- 

30/10/21

Hb- 9.5

TLC- 37000

PLT- 2.88

31/10/21

Hb- 8.9

TLC- 44000

PLT- 2.90