Dr. Penchilaprasad Kandikattu
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 69-year-old female with a long history of rheumatoid arthritis. On Monday, I started to develop a fever. Two days later, it continued with headache and lack of appetite, fatigue, and weakness, sleepy and spent more than normal hours sleeping. (Between 9 to 12 hours). On Thursday, I did a PCR test, and I went to the emergency room. All vital signs were fine except for the fever. I was prescribed Paracetamol 500 mg three times a day and Zithromax 250 mg 1 pill for ten days. In the early morning of Friday, I got the COVID-19 test result, and it was negative. I started to take the pills. However, I started to get diarrhea. On Saturday, I continued taking the medications, and diarrhea got worse (3 to 4 times a day). I also have a lack of appetite and nausea. Therefore I decided to stop all the medications until I see the doctor. On Monday I met the doctor. He advised me not to take any medications until I do complete blood, stool, and urine tests. (To get complete results, including urine culture, it requires 3 to 4 days). On Thursday, the fever reached 39 Celsius (102.2 F). I got diarrhea more than eight times. Therefore, I went to the emergency room, and I got Paracetamol. I am attaching what I got so far from the blood test. I am still waiting for the urine culture test result to be shown to my doctor to decide what to do next. I have a fever, lack of appetite, fatigue, weakness, sleepiness, and diarrhea. I need to get your advice as well as a diagnosis based on the information provided. Am I in a life-threatening situation? I do not know what to do.
Hello,
Welcome to icliniq.com.
I have gone through all your investigation reports (attachments removed to protect the patient's identity). All investigations showing normal except serum Calcium levels are very low and Vitamin D levels also.
Probably you are suffering from viral fever with antibiotic-induced diarrhea. In fever patients, we will also advise Widal tests, malaria, and dengue antibody.
So use tablet Paracetamol 650 mg thrice a day for five days. Use probiotics like tablet Sporlac (Lactic Acid Bacillus) two tablets thrice a day after food. Avoid oily, spicy food. Use capsule Bio-D3 plus (Calcium+ Vitamin D3) once a day for two weeks.
Use tablet Loperamide 2 mg twice a day for five days for loose stools. Take a soft diet only. Avoid caffeinated drinks and ice creams. Also, post stool culture report also. Use antibiotics under your physician's guidance. If you still have queries, please feel free to ask.
Take care.
Patient's Query
Hello doctor,
Is there a possibility of COVID-19? I got tested for another PCR, and I am supposed to get the result in 24 hours.
Hi,
Welcome back to icliniq.com.
Yes, there is a possibility of a COVID infection. Also, a few patients may present with diarrhea with fever. An antigen test may come negative, but still, infection will be there. So you can repeat the COVID RNA PCR (polymerase chain reaction) again.
Take care of your health.
Please post the report.
Patient's Query
Hello doctor,
They did an X-ray, and it shows a moderate infection, especially on the right side (pneumonia). The SpO2 is 88. Therefore, they put oxygen to increase the SpO2. The blood pressure is 90/60. I eat only a little since yesterday. We are still waiting for the COVID-19 test result. What are my chances? Is this a critical condition? I have also attached some more test results. One which is concerning me is BNP.
Hello,
Welcome back to icliniq.com.
Do not worry. In the case of COVID pneumonia, it has to be confirmed by the HRCT chest. Need oxygen support. You will recover soon. Need to be started on Remdesivir with low-dose steroids. Antibiotics and good nutrition support are sufficient. At least it will take one week to recover. Please take care of yourself. Also, get D-dimer, echocardiogram, procalcitonin levels, CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), ferritin, and IL (interleukin) 6 test done. These are the inflammatory markers for COVID infection.
Review with the reports, and still, if you have queries, please feel free to ask.
Take care.
Patient's Query
Hello doctor,
How about the low blood pressure? It is getting low. I am worried about sepsis.
Hi,
Welcome back to icliniq.com.
Sepsis was also decided by the above investigations, total leucocyte count, and serum LDH levels. If sepsis is confirmed, then the need for broad-spectrum antibiotics with supplementation of IV fluids is enough. Do not worry, and you will recover soon. If you still have queries, please feel free to ask.
Take care.
Patient's Query
Hello doctor,
I just got the second COVID-19 test result. It is also negative. So why am I having all of these explained health issues?
Hello,
Welcome back to icliniq.com.
I have not got the CT scan report. Could you please attach the CT scan report if possible?
Patient's Query
Hello doctor,
I have attached the file.
Hi,
Welcome back to icliniq.com.
It is showing that the file is attached, but no file is attached. If possible, please take a screenshot and message me or type the report and message me.
Thank you.
Patient's Query
Hello doctor,
I have attached the file doctor. Please find the file attached in PDF format and do the needful.
Hi,
Welcome back to icliniq.com.
You have not attached your radiologist's CT report. Your radiologist studies the film and gives a final impression, and gives the CT severity index score. I am not a radiologist, but I have gone through the CT images showing there is an involvement of right upper and middle sub plural region opacities with left mid or lower region opacities. Probably CTSC>10 (this impression varies from the radiologist report). So this may be COVID pneumonia with moderate grade may need admission and antiviral therapy. Treatment may vary according to the final impression of the radiologist's report. So please consult with your physician. He will examine and treat you accordingly.
Take care.
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