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Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise?

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Answered by

General & Family Physician
Practicing since : 2009
Answered : 9387 Questions
Question
Hello Dr.

Myself husband of Ms. XXXXXX

She s been under ur guidance from quiet some time now,
Since morning she has been feeling chills , followed by fever and weakness.
she first experienced chills around 8 in the morning and they were really bad. she was shivering badly..then after half an hour her shivers subsided n there was fever ...i gave her paracetamol... then she sweated a bit n was normal by noon ..weak though.... then again around 1600 hrs she started shivering badly... again same things followed..this time no paracetamol was given.
She s on her medicine of METFORMIN since 4th July. twice daily.
Please advise doc.
I am XXXXX, n sailing presently with my wife XXXXX ...please advise if i should take her back home or is this normal fever ?
Posted Fri, 27 Sep 2013 in Medicines and Side Effects
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Infection; relate to symptoms to find exact cause

Detailed Answer:
Hello sir and welcome.

Thank you for writing to me.

I understand you are concerned, but I would like to request you to ask whether she is experiencing any of the following:
-Frequent urination
-Burning sensation while urinating
-Less amount of urine passing each time she urinates
-Blood in her urine
-Abdominal pain
-Back pain
-General body and joint pain
-Vomiting and nausea (if yes, how many times and what was the last thing she ate before she experienced this?)

Please write back to me with the symptoms XXXXX has from the list of symptoms mentioned above.

I am waiting for your answer eagerly to help you take this forward. For now symptoms resemble that of a UTI) which is commonly encountered while travelling, or that of a viral infection which could be caused by tick/mosquito/other insect bites or a stomach infection.

Best wishes.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 56 minutes later
Thanx doc for replying.
Please note following.

Frequent urination... YES (SOMETIMES ..NOT REGULARLY)
-Burning sensation while urinating....NO
-Less amount of urine passing each time she urinates ...YES...SHE URIANTE 3-4 TIMES TO EMPTY HER BLADDER
-Blood in her urine..NO
-Abdominal pain...NO
-Back pain...NO
-General body and joint pain... TODAY HER ANKLES ARE PAINING. HER HEAD IS HEAVY.

-Vomiting and nausea (if yes, how many times and what was the last thing she ate before she experienced this?)...NO

And she is feeling very weak in general. Today she was not even able to go for her meals in the evening.

P.S. Mosquitos are not there on ship.
 
 
Answered by Dr. Shoaib Khan 15 minutes later
Brief Answer:
Could be a UTI; Treatment mentioned

Detailed Answer:
Hello once again sir.

Based on the reply, I would assume a urinary tract infection, but I would still want to conduct a urine examination. Is there a doctor on board the ship who can conduct a physical examination, a urine examination and are there any medical supplies on the ship?

If yes, then the doctor will be able to prescribe antibiotics for Amarjit, but if not and I were your doctor I would like for you to initiate the following:
-Antibiotic tablet NITROFURANTOIN twice daily for 7 days
-Di Sodium Hydrogen Citrate- Syrup (also called CITRALKA in India, but I am unaware of your location so I have mentioned the brand name as well) 2 tsp to be taken three times a day
-Give her plenty of water to drink, she should not get dehydrated
-Try to give her cranberry juice (if available on the ship) as often as possible
-Bed rest
-Avoid sexual contact even after she recovers, for at least 7 days after the last dose of the medication

Please write back to me informing me about her response to the medication, because if she does not notice an improvement within 48 hours of initiation of the antibiotic, we might have to change it. I hope you understand it is a little difficult to accurately treat her without conducting a few laboratory investigations. But only as you are at sea and we do not have any other options, I am prescribing the medications.

I hope XXXXX finds relief with these medicines and you or her write back to me informing me about the good news. Wishing her a speedy recovery.

Best of luck and god bless.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 26 minutes later
Thanks Dr for replying.

Unfortunately there is no doctor on board ship who can conduct urine analysis.
but the antibiotics can be arranged from ship.
I'll inform you as n when i get these medicines or whatever antibiotics are available on ship.
Thanks once again
and can she continue her METFORMIN ?
 
 
Answered by Dr. Shoaib Khan 5 minutes later
Brief Answer:
Please keep in touch; discontinue metformin

Detailed Answer:
Hello once again sir.

Yes, please do write back to me as soon as you get your hands on these medications, and if not, what alternatives you have available; especially the antibiotics.

I would advice you to discontinue the metformin till she recovers, as her intake is low right now and the use of metformin could further reduce her blood sugar levels.

I really hope she recovers soon.

Do keep in touch sir. Best of luck.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 17 hours later
Good Day Doc.

I have not found that antibiotic onboard.
We have erithromycin onboard.
Can it help ?
She was having 100 fever in the morning @1000 hrs and now it was 102.8 @ 1600 hrs. I gave her paracetamol tab.
The problem is that ship staff cannot give med on their own.
They have to send symptoms to their company doc then doc advises from office.
So they have sent it today n we r waiting reply.
I have juss paracetamol at my disposal as i brought it from home.
Rest ill keep u updated.

Regards.
 
 
Answered by Dr. Shoaib Khan 14 minutes later
Brief Answer:
Erythromycin can be tried, but must need approval?

Detailed Answer:
Hello once again sir.

Thanks for keeping me updated.

It is sad that this protocol is not followed urgently, we could try erythromycin for now, as we are left with no other options. But I am guessing they will not give you the same without the advice of your company doctor, I just hope and pray he replies at the earliest. In the meantime, give 1 tablet of paracetamol after each meal three times a day. Keep her hydrated and do prepare liquid food (eg. soups) which she will be able to easily digest for now.

I hope the company doctor replies at the earliest with orders and a prescription. Keep me updated sir.

Take care.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 3 hours later
Good Day Doc

I v got mail from company Doc...he has recommended CIPROFLOXACIN 250 MG.

PLEASE ADVISE , CAN WE TAKE THIS?

P.S. she has history of typhoid as well.
last year she was suffering from that , then itt was fine ..but we didnt take any vaccine after that.

her fever now is 101.2

it is howering between 100 and 102. amd shivers are still there.

please advise., so that we cn start with CIPROFLOXACIN.

shud we do 3 day , 5 day or 7 day couse ?

Regards.
 
 
Answered by Dr. Shoaib Khan 5 minutes later
Brief Answer:
Yes, please start the antibiotic immediately

Detailed Answer:
Hello once again,

Ciprofloxacin is just fine. If taken in a 250 mg dose, I would recommend you take it twice a day, for 5-7 days, depending on her response.

Please write back to me on the 5th day, before the 10th dose of the antibiotic, with her general condition, and we shall then decide whether or not to continue the antibiotic for another 2 days or not.

In the meantime, do continue with all my other recommendations. I wish a speedy recovery, so she can also write to me telling me about the good health soon.

May god bless both of you with good health forever.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 10 hours later
thanx dc.

but her fever is not subsiding now.

i gave her cipro , but she s having fever constant 103 , shud i give paracetaol also ?
please advise , why hr fever is not subsiding n she s feeling cold as well , n shivers.
 
 
Answered by Dr. Shoaib Khan 5 hours later
Brief Answer:
Paracetamol one tablet three times a day

Detailed Answer:
Hello sir.

I would like to start by saying that each individual has a specific response to a specific antibiotic. For example, an antibiotic which might be helpful in treating an infection in me, might not help you at all because you might be resistant to it. Which is why I wanted to conduct a urine culture examination to find out which antibiotic will be effective in , but unfortunately we cannot do this as you are on board.

This is why, treatment with cipro is just a shot in the dark as we have no other option but to try. If cipro is effective in , she will experience a response/improvement within 48 hours of starting the medication. If not, we will have to change the antibiotic. I hope I have successfully explained this to you.

We can only hope and pray responds to cipro. In the meantime, you can give one tablet of paracetamol to three times a day to help with the temperature. The temperature will automatically start coming down once the antibiotic starts taking effect.

I hope this is clear sir. Please keep in touch with me and keep me updated about general condition.

God bless both of you.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 1 hour later
Many Thanks doc...
yeah ..rite now also she s shivering badly... tempreture is 101 though.... but shivers are bad.... she has taken 2 tablets of cipro.... and i think u r right... she mite be resistive to cipro..but lets c after 48 hours ..she mite improve.... i am juss keeping my fingers crossed.
i cant understand her chills....they come n go after bout half an hour.....followed by steep rise in tempretures.
her urine is pale yellow in colour now....not burning sensation... it was cloudy but no it is pale yellow....please advise about shivers ...

Regards.
 
 
Answered by Dr. Shoaib Khan 8 minutes later
Brief Answer:
Shivers will come down with infection,no treatment

Detailed Answer:
Hello sir.

I hope she is not resistant to cipro, and I am also keeping my fingers crossed. But we need to wait for at least 48 hours to decide.

About the chills/shivers, there is nothing much we can do now sir. We have to just keep her warm, and wait for the temperature to come under control. Once the infection has started being tackled, the chills/shivers will also come down.

Keep feeding her with warm fluids, which should help. Keep in touch sir. I am here to guide you through each step of recovery.

Best wishes.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 5 hours later
Good day Doc..

XXXXX fever is 101.9 @ 1700 hrs., and shivers are there.
I am giving her warm soups n all.

we have thses med also here..

calpol

hifenac p

flagyl

ranitin

dart

almox 500

please advise.

regards...
 
 
Answered by Dr. Shoaib Khan 6 minutes later
Brief Answer:
Flagyl 500 mg, twice a day; hifenac-p twice daily

Detailed Answer:
Hello sir.

Flagyl is a good medication, available in 500 mg, it can be taken twice a day. If you can gain access to this particular medication, I would like yoy give flagyl 500 mg twice a day for 7 days. Also, try to get the hifenac p, which should help in taking care of her chills and temperature better than the paracetamol.

Hope this helps sir.

Take care.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 33 minutes later
Thanx doc..
I have got 15 tab of flagyl 400 and 15 tab of hifenac p.
Should we continue with ciplofloxacin , or shud flagyl be started with ciplofloxacin ?
and please advise dosage for hifenac p ...
Can u please tell me what is this flagyl 400 for ?
please advise.

Regards.

 
 
Answered by Dr. Shoaib Khan 26 minutes later
Brief Answer:
Flagyl one tablet, twice a day, for 7 days

Detailed Answer:
Hello once again,

Flagyl is an antibiotic used to treat some of the most common and at times resistant infections also. So this flagyl should help in better tackling the infection XXXXX has.

Take flagyl 400 mg twice a day for 7 days, and then hifenac-p one tablet twice a day, for 5 days. Continue with the cipro for now sir. We are hoping XXXXX responds to either one of the antibiotics. Please keep me updated on any developments.

Best of luck and god bless.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 2 hours later
Thanks a lot doc.

I gave her ciplo , flagyl and hifenc p . these were given after dinner.

her fever reached 104.2 . then she started sweating and now it is coming down slowly.

I'll keep u updated about her general condition.

Many thanks again.

Regards.
 
 
Answered by Dr. Shoaib Khan 4 minutes later
Brief Answer:
My pleasure entirely

Detailed Answer:

You are most welcome.

I am as worried about XXXXX as you are. Do not worry, she should be fine soon.

God bless.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 5 hours later
Good Day Doc

yesternight after dinner i gave her all 3 meds as i told u ciplo , flagyl and hifenc p .
her fever reached 104....was alarming .... then i started doing cold strips on her forehead...n she also started sweating at same time....her fever was normal within one hour.Her body was hot as anything , but within an hour she was back to normal....cold body .. ..her backache vanished n her headache was also gone.... she urinated ,... but not full..she wanted to do more but it dint come.... but feeling was there ... n now .. she s not able to sleep... she is fine now ..but not able to sleep now... is this because of some antibiotic that we gave ... n bout her urine also.. due to antibiotic only ?.is this normal ????

please advise.
 
 
Answered by Dr. Shoaib Khan 6 hours later
Brief Answer:
Both symptoms of the infection

Detailed Answer:
Good Day sir,

The incomplete feeling of urine evacuation is one of the symptoms I had mentioned in one of my earlier responses, where I asked you to check if XXXXX had those particular symptoms. This one is related to: -Less amount of urine passing each time she urinates. This is commonly seen with the type of infection that she has.

The difficulty in sleeping is purely due to the fever and infection, do not worry, these are normal reactions, but are not side effects of the medicines. They are all symptoms of the infection.

Keep her well hydrated, give her plenty of water to drink and also cranberry juice if available on deck. I am sure she will be fine soon.

Keep me updated sir. Take care.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 3 hours later
Good Day Doc .
Many thanks for ur online hep....XXXXX s feeling good now... though lack of sleep.
after that 104 fever came down she been normal ..no fever ... just mild...99..... n no chills as well.... yes ...i am giving her cranberry juice n warm soups.... what all she needs to avoid....food vise.... can she eat rice ? ... because lunch ime is alwaz rice here .... though i m giving her soups regularly ..... till now @ 1300 hrs .. she s feeling good ... but deprived of sleep. Rest everything is good... She passed stool as well in the morning.
P.S. sheis suffering from white boils in her mouth.
please advise.
She ha taken jus cipro in morning.

Many thanks again.

Regards
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Can give her anything to eat

Detailed Answer:
Hello sir.

I am so happy to hear about XXXXX recovery. It is indeed great ews. Continue with all my suggestions and also all the medicines as adviced.

The antibiotics need to be taken for at least 7 days, so please keep in tiuch with me, informing me about her response and do not discontinue the medicines even if XXXXX recovers completely. Please also write to me before the last dose of the medicines, I.e. the 7th day.

As for her diet, you can give her anything that she likes and wishes to eat, but also continue with as much fluid as she can tolerate. Why has she taken only cipro, do continue with the flagyl and hifenac-p as well.

Don't worry sir, she will sleep well soon. I wish both of you a beautiful, healthy and happy life ahead.

God bless.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 51 minutes later
hello docter
thanks a million u really help us in our hard times
taking medicines on ship without the approval of company docter is a crime
they dont know that we are seeking medical help form u.
It is a long process to consult company docter on ship and that too directy
there chief officer through him we can talk rather mail .
But at night her condition was really bad she was suffering form 104 fever
i was really nervous
so without listening his advice i gave her medicines that u mentioned along with ciprofloxin he strictly adviced only ciprofloxin.
Now the ship is on anchor and within few days we reach at some port.
Docter told us to take her to nearest hospital for physical examination
where they will conduct the necessary test and mail to the company docter
so thats why i have given only ciprofloxian .That other medicines u have adviced i have got from one of my friend on ship luckily.Now u advice should we continue that drugs because i m worried about their reaction also when they found other drugs in her urine or blood sample.
Is it possible for me to continue her other on that medication
once again many many thanks
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
If XXXXX worsens continue flagyl

Detailed Answer:
Hello sir.

I completely understand that you are under a lot of pressure to choose the right medication. But I should make it clear that if XXXXX responded to the flagyl and started recovering, then discontinuing flagyl will only make her condition worse.

If cipro was in fact responsible for her recovery, then she will recover even without the flagyl. But if you see that she is again getting worse then it would be mandatory for you to re-initiate the flagyl and hifenac-p, immediately. Do not worry, they will not really do a drug test on XXXXX urine.

I hope this information helps. I am always available to help both of you.

Take care and best of luck.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 41 minutes later
Hello Doc,

now @ 1700 hrs her fever is 102 , with no shivers.
I juss gave her cipro after breakfast , thats it.
no shivers and chills are there , so please advise shud i give flagyl , or do u think that cipro is working.
Please advise.
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Restart flagyl and hifenac-p

Detailed Answer:
Hello sirji.

A sign of the fever returning could be due to the withdrawal of either flagyl or hifenac-p. Please restart both, and do not discontinue them until the course is over.

XXXXX health is most important right now. We will decide whether to continue the flagyl for 7 days or not later. But for now, please continue all the medications.

Hope this helps. Keep me updated sir.

Best wishes.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 30 minutes later
thanks docter
U really come in our lives as blessing.
I WILL RE CONTINUE HER MEDICATION
Hope u are not fed up with us
thanks
 
 
Answered by Dr. Shoaib Khan 42 minutes later
Brief Answer:
Please do not embarrass me, always welcome

Detailed Answer:
You are most welcome sir.

No sir, how can I be fed up of you. I am always here to help.

Please understand this, I am here to answer your queries, anytime, any place. Please do not think twice before writing to me.

God bless both of you.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 1 hour later
Thanks a lot doc.

I'll keep u posted about her general health.

Regards.
 
 
Answered by Dr. Shoaib Khan 17 minutes later
Brief Answer:
Thanks and god bless

Detailed Answer:
Hello sir.

May god bless the both of you with good health always. Thanks for keeping me in the loop.

Best wishes.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 15 hours later
Good Day Doc .

first of all thanks for everything.
Now , XXXXX feeling OK.... but she s too week to even sit for half an hour. Her fever is hovering between 98 and 99. Her fever as of now @ 1300 hrs is 98.8 .Do we need to give her some supplements of vitamins n all.. please advise.

Regards.
 
 
Answered by Dr. Shoaib Khan 9 minutes later
Brief Answer:
No supplements required as of now

Detailed Answer:
Hello sir.

Thats great news. So I am guessing the flagyl is what has helped her. Ypu should thank your friend who supplied you with flagyl.

I can understand she is weak, try to give her boiled meat; not fried or oily meat. Meat in her soup will help her regain her energy. We need not initiate supplements yet sir, once she has recovered completely she should regain all her energy back. Only if she doesn't we shall consider the supplements. As of now, they wont be required sir.

Keep me updated.

God bless.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 42 minutes later
Hello Doc.

She will not take that as she is pure vegetarian

Please suggest something else

Regards
 
 
Answered by Dr. Shoaib Khan 47 minutes later
Brief Answer:
Fresh vegetable soups and fresh milk

Detailed Answer:
Hello sir.

My apologies. In that case give her vegetable soups, made with fresh vegetables, noy packed food. Warm milk will also greatly help, if available.

I am sure she will be fine in no time. Her body is fighting the infection and utilizing all her stored energy, which is why it will take sometime for her to regain her energy. Do not worry sir, recovery might be slow, but it will surely happen.

Thank you and take care.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 33 minutes later
Hello Doc.


I will give her vegetable soups. Fruits are also available on ship .But milk available is life long milk i.e pasteurized one when she joined the ship she used to drink milk as she is a milk lover but that doesnot suit her and she got foodpoisining. Right now i m giving her brown bread with lentils ,fruits, soups in the evening.Fruits available are apples, pears, plums ,oranges,banana,watermelon,kiwi.
My contract is about to finish by the end of this month ,then we will be at home where i can better take care her.Here i have to go to work leaving her alone in the room . But the chief engineer and captain are very supportive allowing me to come inbetween my workhours to see her and you too a support

Thanks
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Continue the same diet, avoid milk

Detailed Answer:
Hello sir.

In that case please avoid the milk, as it has to be fresh and help XXXXX recover.

It is nice that you will soon be able to get medical care for XXXXX , but I am sure she will be fine in no time. And moreover, I am always available for any/all help you need from me.

Do not worry sir. You have taken care of her well, and I am sure XXXXX knows how lucky she is to get such a wonderful husband like you.

God bless both of you.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 26 minutes later
Thanx a lot Doc for those nice words.
I am trying to give her watever possible onboard , n praying that i sign of in time now.
rest everything s fine.
Thanx a lot for being there alwaz.

Regards.
 
 
Answered by Dr. Shoaib Khan 45 minutes later
Brief Answer:
Most welcome, god bless

Detailed Answer:
Hello sir.

You are most welcome. Do give her everything fresh and clean, other than the fruits, do see to it that everything is boiled.

My best wishes.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 18 hours later
Good Dya Doc ,

First of all Many Many thanks for being so supportive.
XXXXX s feeling very fine now. Her fever is gone almost. She just had 99 fever last night. Now she s feeling good. She s feeling so fresh after taking bath today. All thnks to God n you.
Now wen we finish this antibiotics course should we restart METFORMIN ?

Please advise.

Regards.
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Great news; metformin to restart later

Detailed Answer:
Hello sir ji.

That is great news, I am extremely happy to hear about XXXXX recovery.

Yes sir, we will have to restart the metformin soon, but not yet. Let XXXXX recover completely, and may be 7 days after her last dose of antibiotics (antibiotics need to be taken for 7 days), we shall restart the metformin. For now, let her rest and relax and eat well so she can regain all her energy.

Once XXXXX has recovered completely we shall close this discussion and open a new one, concentrating completely on her fertility and soon, conception as well.

Only god is to thank sir, I am just a common man.

Take care and god bless.
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Follow-up: Feeling chills followed by fever and weakness. Using paracetamol and metformin. Advise? 30 minutes later
Hello Doc..

I have no words to thank u

And u are not common man at least for us .You are very very special man .

May we get a chance to XXXXXXX u so that we can at least say " thanks" properly

God has send u to help us

Regards
 
 
Answered by Dr. Shoaib Khan 44 minutes later
Brief Answer:
Thank you for your kind words

Detailed Answer:
Hello sir.

If god permits we shall surely XXXXXXX Do keep in touch til XXXXXX recovers completely, after that we shall closr this discussion and concentrate on XXXXXX conception.

God bless both of you.
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