COVID with ICU psychosis
JAHNAVI CHATLA 
ROLL NO. 18
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I have been given this case to solve in an attempt to understand the topic of " Patient clinical data analysis" to develop my competancy in reading and comprehending clinical data including history, clinical finding, investigations and come up with a diagnosis and treatment plan
CASE DISCUSSION
A 55 year old Male patient who is a resident of Yadhaadhri Bhuvanagiri has come to Opd with chief complaints of
1. Dry cough since 15 days
2. Shortness of breath since 10-15days
HISTORY OF PRESENTING ILLNESS
The patient was apparently asymptomatic before 20 days
He then developed Fever which is of Insideous in Onset and of intermittent type without chills/rigors
He was tested positive of SARS COV-2 on 30th of April,2021.
He then got admitted to HOSPITAL-1 and was referred to HOSPITAL-2 because of shortage of oxygen supply.
In HOSPITAL - 2 he developed
1)Dry cough which is 15 days of duration,insideous in onset, gradually progressing type without any diurnal or postural variations. There were no known aggravating factors and it was relieved on medication
2)Shortness of breath which is 10-15 days of duration, Insideous in onset, gradually progressive and was of Grade 3 (NYHA) with no known aggravating factors and was relieved on oxygen supplementation.
He was tested negative on 12th May,2021 and was discharged from Hospital-2 on 13th May,2021 at 1.42 p.m
He again was admitted to Hospital-3 (present hospital) for oxygen supplementation.
Date: 13/5/2021 9:51 p.m
On presentation, the patient was with Dry cough and Shortness of breath. He was irritable, restless and passed urine on the floor.
Date: 15/5/2021
Patient was very irritable and was not keeping his oxygen mask in place,was trying to remove cannula and didn't sleep properly.
Hence he was referred to Psychiatry for further evaluation
CONSULATION NOTES FROM PYSCIATRY at 2.00 p.m
Date: 22/5/2021
SOB decreased but persistent
no fever spikes
sensorium - good
O: spO2 95 % at 10 litres of o2, incentive spirometry,over T/P/P
ICU Psychosis (resolved)
PAST HISTORY
1. The patient is a known case of Hypertension since 2 years
2. He had a Cerebrovascular Accident (CVA) 2 years ago leading to Left sided Hemiparesis.
FAMILY HISTORY
No significant Family history.
None of his family members are tested COVID positive
PERSONAL HISTORY
DIET - Mixed
APETITE - Decreased
SLEEP - Inadequate
BOWEL AND BLADDER MOVEMENTS - Normal
ADDICTIONS - Occasional alcohol intake (monthly once)
DRUG HISTORY
DRUGS PRESCRIBED BY OUTSIDE HOSPITAL
Inj. Meropenem 500mg/IV/ BD
Inj. Methylprednisolone 250mg/IV/stat
125mg/IV/BD
Inj. Penclav IV/OD
Inj. Remdesivir 200mg/IV/ stat
Tab. Dolo650 TID
Tab. Montac BD
Tab. Mucinac 600mg TID
Vit-C OD
Vit D5 OD
DRUGS PRESCRIBED DURING DISCHARGE
Tab. Omnacortil 20mg OD (1 week)
10mg OD (1 week)
Tab. Abphylline-SR OD (10 days)
Tab. Rablet-D OD (10 days)
Tab. Myelin forte OD (10 days)
Tab. Thymotos OD (30 days)
Tab. Ecospirin 75/10mg OD
Tab. Dabistar 110mg OD (15 days)
Oxygen 6-7 lt/min
DRUGS PRESCRIBED BY HOSPITAL-3 AFTER REFERRAL TO PYSCIATRY
O2 inhalation to maintain spo2 of 92%
IVF 10NS with optineuron 75 ml/hrs
Inj dexamethasone 8mg IV OD
Inj clexane 60mg sc OD
Tab dolo650mg sos
Tab gabapentin 100mg BD
Tab olanzapine 2.5 mg OD
GENERAL EXAMINATION
The patient is conscious, coherent, cooperative and well oriented to place and person but not to time
He is moderately built and well nourished
PALLOR - Absent
ICTERUS - Absent
CYANOSIS - Absent
CLUBBING- Absent
LYMPHADENOPATHY -Absent
EDEMA - Absent
VITALS÷
Temperature- Afebrile
Pulse- 116 bpm
Respiratory Rate- 38/min
Blood pressure- 110/70
Spo2- 85% on RA
91% on 12 lt of O2
SYSTEMIC EXAMINATION
RS - Normal vesicular breath sounds heard
CVS- s1 and s2 heard. No added murmurs
PA- Soft and non tender. No organomegaly
CNS- Intact
LOCAL EXAMINATION
No external injuries or scars seen
INVESTIGATIONS
REPORTS FROM HOSPITAL- 1
Date : 30/4/2021
Complete blood picture
Liver Function test
CT scan
CORADS:6
CT SEVERITY SCORE: 21/25
D-Dimer
CRP
IL-6
REPORTS FROM HOSPITAL-2
Date : 4/5/2021
Complete Blood Picture
D-Dimer
LDH
X RAY 5/5/2021
10/5/2021
11/5/2021
Date: 13/5/2021
Complete Blood Picture
Serum values
D-Dimer
REPORTS FROM HOSPITAL- 3
Date: 14/5/2021
COMPLETE BLOOD PICTURE
D-Dimer
Date:16/5/2021
CRP
Date:17/5/2021
D-Dimer
Date: 19/5/2021
Chest X-ray
Date:20/5/2021
Saturation Charting
PROVISIONAL DIAGNOSIS
Viral pneumonia secondary to COVID infection with ICU pyschosis (known case ofHypertension and CVA episode.)
Ct score: 21/25
CORADS : 6
TREATMENT
Head and elevation
O2 inhalation to maintain spo2 >92%
IVF 10 NS with optineuron
Tab Dolo 650mg
Tab Gabapentin 100mg BD
Tab olanzapine 2.5 mg OD
Monitor temperature BP PR SPO2
GRBS 8hrly
PROBABALE QUESTIONS
1)Which subtype of ICU psychosis did the patient land into according to his symptoms?
2)what are the risk factors in the patient that has driven this case more towards ICU pyschosis?
3)The patient is sleep deprived during his hospital stay..Which do u think might be the most propable condition?
A) Sleep deprivation causing ICU pyschosis
B) ICU psychosis causing sleep deprivation
Probable reasons to be landing in ICU pyschosis
Assessing a ICU psychosis patient
Sleep deprivation in ICU pyschosis
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