16 year old male came to casualty with c/o fever

This is an a online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.
This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.
I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan
The patient/ attender was informed the purpose of the information being acquired. An informed consent was taken from patient/ attender and there is omission of information that was requested to be omitt. 

A 16 year old Male came to casualty with 
C/O fever since 4 days
vomitings 6-7 episodes per day since 4 days, bilious, food as particles
C/O Generalised weakness, bilateral leg pain since 4 days
C/O loose stools 4-5 episodes per day,liquid in consistency since 3 days
Decreased urine output since 3 days
Epigastric pain since morning

Pt was apparently asymptomatic 4days back then on 17/10/22 night after consuming alcohol he developed fever, high grade, intermittent not associated with chills and rigor  Continued for 4 days rel?
He had 7-8 episodes of vomitings since 4 days which is bilious, projectile type
He has generalised weakness with bilateral leg pain since 4 days
He has 4-5 episodes of loose stools(liquid consistency) per day for 3 days
 Decreased urine output since 3 days
Epigastric pain since morning,dull aching type,not radiating type
No H/O burning micturition,headache
Addictions: alcohol since 6 yrs(occationally-2,3 times per week
cannabis since 6yrs(1-2smokes per day)
tobacco smoking since 6yrs(daily 10 per day)
K/C/O epilepsy since 4 yrs (not on regular since 2yrs medications)
N/K/C/O HTN,DM,TB,asthma,Thyroid,CVA,CAD
Occupation:fast food master(stopped studying at 7th class(4 years back))
Sleep-inadequate
Mixed diet
General examination:
No pallor
No icterus  
No cyanosis 
No clubbing 
No generalized oedema

Vitals:  
On admission 
Pt is Conscious, coherent, cooperative 
Temp: 99.1F
PR: 98BPM
RR: 16Cycles per min 
BP: 80/60 mmhg 
Spo2: 99
GRBS:118mg/dl

      Systemic examination:

CVS examination:
S1S2+

Respiratory system examination :
Bilateral Airway E +

Per abdomen examination:
Soft, tender+ right and left hypochondrium and epigastrium, bowel sounds+

CNS:N

Diagnosis:
Pyrexia under evaluation with thrombocytopenia
Acute kidney injury(?acute glomerulonephritis)

USG Abdomen:
Bulky kidney's with raised echogenicity of both kidney's
Mild hepatomegaly 

on22/10/22
On 25/10/22
On 26/10/22

Treatment:
Day-1:
I/U:1000/200ml
BP:100/50mmhg
PR:75bpm
SpO2:97 @RA
Temp:99.3F
CVS:S1S2+
RS:BAE+
P/A:guarding RT HC+, epigastric tenderness
CNS:NFD
1.IV.FLUILDS 2 NS,1RL @100ml/hr
2.T.DOXYCLYINE 100mg PO/BD
3.INJ.MONOCEF 1gm /IV/BD
4.INJ.PAN 40mg/IV/OD
5.I/U CHARTING
6.INJ.ZOFER 4mg/IV/BD
9.T.SPOROLAC/PO/BD
10.INJ.LASIX 20mg/PV/if SBP more than 100mmhg

Day:2: 
ICU bed 4 
24/10/22
Day2
S:
Fever spikes+
Dry cough since night
Decreased urine output
1 episode of vomiting at night
Stools not passed since yesterday 

O:
Pt is C/C/C
BP:120/80mmhg
PR:86bpm
SpO2:98%@RA
RR:21/min
Input/Output:2800ml/200ml
Temp:100F
CVS:S1S2+
RS:BAE+
P/A:soft,NT
CNS: NFD

A:
PYREXIA UNDER EVALUATION WITH THROMBOCYTOPENIA
ACUTE KIDNEY INGURY(?GLOMERULONEPHRITIS)
1.IV FLUIDS 2 NS, 2 RL@100ML/HR
2.T.DOXYCLYINE 100mg PO/BD
3.INJ MONOCEF 1 gm/IV/BD
4.INJ PAN 40 mg/IV/OD
5.T.SPOROLAC/PO/SOS
6.INJ.LASIX 20mg IV if SBP more than 100mmhg
7.PLANNED FOR DIALYSIS 

Day-3
S:
Dialysis done on 24/10/22 @8:30pm to 10:30pm
Fever spikes subsided
1 episode of vomiting at night
Occasionally dry cough

O:
Pt is C/C/C
BP:110/80mmhg
PR:84bpm
SpO2:97%@RA
RR:22/min
Input/Output:1100ml/350ml
Temp:99F
CVS:S1S2+
RS:BAE+
P/A:soft,NT
CNS: NFD
Urine passed 
Stool passed

A:
PYREXIA UNDER EVALUATION WITH THROMBOCYTOPENIA
ACUTE KIDNEY INGURY(?GLOMERULONEPHRITIS)

P:
1.IV FLUIDS 2 NS, 2 RL@100ML/HR
2.T.DOXYCLINE 100mg PO/BD(D3)
3.INJ MONOCEF 1 gm/IV/BD(D3)
4.INJ PAN 40 mg/IV/OD
5.T.SPOROLAC/PO/SOS
6.INJ.LASIX 20mg IV if SBP more than 100mmhg

Day-4
ICU bed 5 
26/10/22
S:
No Fever spikes
No vomitings

O:
Pt is C/C/C
BP:120/70mmhg
PR:84bpm
SpO2:96%@RA
RR:24/min
Temp:98.4F
Input/Output:2600/550ml
CVS:S1S2+
RS:BAE+
P/A:soft,NT
CNS: NFD
Stool passed

A:
PYREXIA UNDER EVALUATION WITH THROMBOCYTOPENIA
ACUTE KIDNEY INGURY(?ACUTE INTERSTITIAL NEPHRITIS)

P:
1.IV FLUIDS 2 NS, 2 RL@100ML/HR
2.T.DOXYCLINE 100mg PO/BD(D4)
3.INJ MONOCEF 1 gm/IV/BD(D4)
4.INJ PAN 40 mg/IV/BD
5.INJ.LASIX 20mg IV if SBP more than 110mmhg

Day-5

27/10/22
No Fever spikes
No vomitings

O:
Pt is C/C/C
BP:110/70mmhg
PR:62bpm
SpO2:94%@RA
RR:24/min
Temp:98.4F
Input/Output:2600/550ml
CVS:S1S2+
RS:BAE+
P/A:soft,NT
CNS: NFD
Stool passed

A:

ACUTE KIDNEY INGURY(?ACUTE INTERSTITIAL NEPHRITIS) 
H/O CANNABIS USE since 6YEARS
H/O ALCOHOLISM since 6 years

P:
1.ORAL FLUIDS 1000ml/Day
2.T.DOXYCLINE 100mg PO/BD(D5)
3.INJ MONOCEF 1 gm/IV/BD(D5)
4.INJ PAN 40 mg/IV/BD
5.INJ.LASIX 20mg IV ifSBP morethan120mmhg
6.SYP. ARISTOZYME 15ml po TID

Day-6

28/10/22
No Fever spikes

O:
Pt is C/C/C
BP:110/70mmhg
PR:68bpm
SpO2:97%@RA
RR:16/min
Temp:98.4F
CVS:S1S2+
RS:BAE+
P/A:soft,NT
CNS: NFD
Stool passed

A:

ACUTE KIDNEY INGURY(?ACUTE INTERSTITIAL NEPHRITIS) 
H/O CANNABIS USE since 6YEARS
H/O ALCOHOLISM since 6 years

P:
1.IVF 2 NS @ 100ml/hr
2.T.DOXYCLINE 100mg PO/BD(D5)
3.INJ MONOCEF 1 gm/IV/BD(D5)
4.TAB.RANTAC150mg po/od
5.INJ.LASIX 20mg IV ifSBP morethan120mmhg
6.SYP. ARISTOZYME 15ml po TID 
7.INJ.ZOFER4mg IV SOS

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