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Have Fever. Started Shivering. Took Paracetamol. Now Getting Headache, Mild Stomach Pain. Remedy?

Posted on Thu, 16 May 2013

Question: We are based out out Noida, India. My wife is having fever for last two days. Fever starts with shivering and reaches upto 103 F. And subsides after having paracetamol in about one hour. She was complaining of Headache and mild stomach pain. What pathological tests should we get done ?

Answered by Dr. A.K. Srivastava (17 minutes later)

Hello

Thanks for writing to H.C.M. for your query.

I have gone through your query regarding fever of your wife for last two days, which comes with shievering and reaches upto 103 F, She is also complaining of headache and stomache.

Considering the symptoms she appears to be suffering from- Viral fever / Malaria / ESR, M.P., Widal test.

(b) Urine- Routine and Microscopic, C/S.

On the basis of these investigations we can pin point our diagnosis and than one can treat accordingly.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. A.K. Srivastava (13 hours later)

Hi Dr XXXXXXX
Got the tests done, blood culture report will be there tomorrow, while urine culture will take two more days.
Meanwhile the following parameters of blood and urine are:
MALARIA Test: No MP seen in smears examined

WIDAL TEST, SERUM (Slide Agglutination)
Salmonella typhi O (TO) Reactive 1:20
Salmonella typhi H (TH) Reactive 1:20
Salmonella paratyphi A, H (AH) Reactive 1:20
Salmonella paratyphi B, H (BH) Reactive 1:20

URINE EXAMINATION, ROUTINE; URINE, R/E
Following parameters were outside normal range
Leucocyte Esterase : Positive
Pus Cells: 0-5 WBC / hpf
Full report is here:
WWW.WWWW.WW
Please let me know the diagnosis.
Thanks XXXXXXX

Answered by Dr. A.K. Srivastava (3 hours later)

Hello

Welcome again in H.C.M. for reconsultation.

I have gone through your investigations reports, The available reports does not favours any specific fever (though culture reports are awaited).On the basis of present reports she is suffering from viral fever. Therefore she should take-

(a) Antibiotic- Ciprofloxacin (500 mg) twice a day.

(b) Tab Rantidine + domperidone like Rabemac-DSR twice a day.

(c) Tab Paracetamol (500 mg) one tab S.O.S.(take when fever is 101 or more)

I hope this will help her , and if culture report indicates any specific infection than antibiotic may be changed according to report.

Wishing for speedy recovery.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. A.K. Srivastava (34 hours later)

Dear Dr,
I have uploaded the Hemogram test just received on this site. Please advice the next step.
Thanks XXXXXXX

Answered by Dr. A.K. Srivastava (45 minutes later)

Hello

Dear XXXXXXX

I can't Down load your reports as my computer warn for virus in your scans, Secondly please tell about her temp at present.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. A.K. Srivastava (38 minutes later)

Dear Dr,
Presently she has 101F. She has a headache. The fever goes up till 103.5F and on Paracetamol comes down to normal for one hour and headache goes away. Thereafter, 1 hour she starts to shiver and headache comes back nad the temperature goes up to 103.5F .
If she takes Paracetamol when the temperature reaches 101F, as advised, then it takes a long time to reach normal temperature, however if she takes paracetamol after 103F the temperature comes down sooner.

HEMOGRAM:
Heoglobin 10 g/dL
PCV : 30.8%
MCV : 78.4 fL
MCH: 25.4 pg
RDW: 15%
Eosinophils (DLC): 0% (ZERO)
Eosinophils (ALC): ZERO thou/mm3
Basophils(ALC): ZERO thou/mm3
Platlet count: 140 thou/mm3

ESR (Westergren): 75 mm/hr

Please let me know, what is the diagnosis and next steps.
Thanks XXXXXXX

Answered by Dr. A.K. Srivastava (31 minutes later)

Hello

Dear XXXXXXX

Haemogram of your wife does not indicates any specific infection, Your report is within normal limits except ESR, But keeping other in view this is not significant. My opinion is this is viral fever and usual course of this fever is 5 to 7 days. But it will be better to consult any physician for examination of lungs and abdomen to rule out any other pathology.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. A.K. Srivastava (12 minutes later)

Dear Dr,

I have uploaded the reports.

Answered by Dr. A.K. Srivastava (4 hours later)

Hello

Dear XXXXXXX

I have review all the reports and all these are not indicating any specific fever , but here I would like to change the antibiotic, your wife is suffering from viral fever this will take about 4 to 5 days more for cure.Now she should be given -

(a) Antibiotic Cefexime (200 mg) twice daily.

(b) Tab Paracetamol (500 mg) twice daily.

(c) Vitamin B-complex One tab daily.

I hope this will help her.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. A.K. Srivastava (57 minutes later)

Dear Dr,
The Urine culture report is normal. It says:
CULTURE, URINE : No Aerobic pyogenic organism grown after 48 hrs incubation at 37°C

As per your advice, we got her chest and abdomen examined by a doctor. Wife's Chest and Abdomen are also clear. I have uploaded her prescription. Also, the doctor has asked to repeat Typhi dot (1gG and 1gM), Widal and M.P

Please advice if we need to repeat the test?

Regards and Thanks for your continued support. XXXXXXX

Answered by Dr. A.K. Srivastava (2 hours later)

Hello

Dear XXXXXXX

Your wife is suffering from viral fever she will be alright in 3 or 4 days. Please wait for 4days. I hope there is no need of repeatition of investigation just now.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. A.K. Srivastava (11 hours later)

Dear Dr,
Today very early morning her temperature touched 104.3 F , she had paracetamol about two hours before.
How to respond to such situation of high temperature. How often can paracetamol be repeated? Do we need to take some special precautions ?

Thanks XXXXXXX

Answered by Dr. A.K. Srivastava (25 minutes later)

Hello XXXXXXX

You may give Paracetamol 3 to 4 times in a day.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. A.K. Srivastava (3 days later)

Dear Dr,
My wife still has fever, though the intensity has reduced, that is, now the XXXXXXX temperature goes upto 102F. She has been having fever for 9th day running. Her first fever was on Friday 12th April.
Please advice if we need to change the course of action?

Thanks XXXXXXX

Answered by Dr. A.K. Srivastava (4 hours later)

Dear XXXXXXX

Please repeat blood test - widal test.

Thanks.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. A.K. Srivastava (8 hours later)

Dear Dr,
I have uploaded the Widal test report.
My wife's fever is milder, 101F and stays for shorter time about 3 hours.

Please advice
Regards XXXXXXX

Answered by Dr. A.K. Srivastava (55 minutes later)

Dear XXXXXXX

I have review the reports, your wife is in recovery phase and will take about 2 to 3 days, during this period she should avoid heavy work, and if needed take only tab paracetamol.

Wishing for speedy recovery.

Regards.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. A.K. Srivastava (2 days later)

Dear Dr,
My wife now have fever of 100F lasting about 2 hours once during day time and once at night. Is is the normal Viral recovery process ? She is having Paracetamol and not doing any heavy work as per your advice.

Please let us know if there is any need to be concerned ? Should she take any vitamins ?

Thanks XXXXXXX

Answered by Dr. A.K. Srivastava (26 minutes later)

Dear XXXXXXX

I hope she is almost recovered. And this is a normal process of recovery.

There is no need to be concerned. She may take vitamin like Revital once a day.

Wishing for cheerful recovery.

Regards.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Mohammed Kappan