SEPSIS PYROGEN [Puerperal Sepsis, Pyrogen]
HOMOEOPATHIC MEDICINE By Praful Barvalia
Jagruti Mazumdar LCEH (Bom.) MICR
[*Medical officer (GMACC) Dr. M. L.
Dhawale Memorial Homoeopathic Medico Surgical Research Centre, Malad
(East). Tel.: 842 6357
While taking rounds in P.N.C. ward at
Dr. M. L. Dhawale Homoeopathic Medico-Surgical Hospital the R.M.O.
informed about one of the PNC patients with C / o. severe abdominal pain,
very foul smelling lochia along with the fever on 2nd PNC day. Her case
was as follows:
25 years old / married: 10 years / G3P2
Ao L2:
Current O.H.: ANC Period uneventful
except Hb: 8.15 gms at 7th month.
labor: fine with no perineal tears /
episiotomy etc.
-Delivered within 2 / 12 hrs. of the
onset of labour.
Post Delivery: 1st day: lower abd pain-
slight since delivery. Lochia: N Lactation: N
O / E: PA : well contracted Rest- NAD
Action: Placebo was taken was placebo
for abdominal pain.
2nd day: lower abd. pain + since
morning, intermittent, walking, lying on abdomen.
Not tried pressure / warm application.
-Backache low since 1 mth with
restlessness for 2 days++
-Weakness
-Bodyache++ for 2 days with
restlessness>+change of position.
-Vagina Pain++ since delivery
-lochia offensive+++-blackish red
-feverishness with chilliness+< Fan -Throat burning +> Warm water
-Headache + for 1 hrs> light
bandage.
-Vomited once after tea at 9 a.m., food
particles seen in vomitus.
Small quantity otherwise no nausea
vomiting.
-Desire3 for warm water3 Thirst
-App Stool-N, C3H2
-O / E G.C. Fair, Pulse>: 120 / m,
Temp. 99.4 F (oral) Breasts(M) (N)
RS / CVS- NAD
PA: Tenderness, Lower Abdomen
uterus: upto midpoint (between
umbilicus and pubis)
PS-Lochia: Offensive++ reddish black.
Fx: Tenderness+- Lateral and Post
Cx: Os closed.
Vagina: Tenderness++
Action: Rhus Tox 200 4hrly. Pyrogen
stat at 1.30 p.m.
2nd day 10pm: SQ. Pyrogen started at 3
p.m. and then continued 4 hrly.
3rd day 11 pm: After 1st dose of
Pyrogen at 1.30 pm. abdominal pain > 75 percent and then (S) with doses
at 5.30 pm and (2nd dose).
-Bodyache and weakness > 75 percent
-No Fever and chill. No vaginal pain.
-Headache: occ.
-Thirst >+, App>+ Taste:
insipid>: Morning->+ Now.
O / E: Appears fresh. Temp. 99.4
degree, Pulse: 120 / m
BP: 110 / 70mm of HG. Rs.: Clear
P / A: Tenderness > 75 percent
P / V. Fx Tenderness > 75 percent,
Foul smell >+ of lochia >
Action: Pyrogen 200 4 hrly.
4th Day 10 am: No abdominal pain /
Headache / Backache / Fever Chill etc. Thirst > App> Lactation (N)
G.C. Fair O / E: Temp: 100 degree F,
Pulse- 80 / m, BP- 110 / 70. RS: Clear
Pa: Tenderness > 90 percent uterus:
Contracted well.
Pv: Tenderness: 10 percent remaining,
Lochia- Foul Smell >+ Action: To observe with placebo
5th day: 10 am: No abdominal Pain
since: yest Occ vaginal pain on walking
Lochia: less bloody, Non Offensive
O / E: temp: 99 degree F, Pulse: 88 / m
P / A: Tenderness+
P / V: Tenderness: Right fornix Minimal
Action: Pyrogen 1M 1 dose stat
6th day: >3 in all aspects.
T.P.R. CHART
12 / 7 / 96 (2nd day) T P R
9.30 am 100.2 100 28
11.30 am 99.4 100 30
1.30 pm 98.8 96 30
3 pm 98.6 98 28
5 pm 98 82 28
7.30 pm 99 84 28
9.30 pm 99.2 88 26
11 pm 100.2 116 30
13 / 7 / 96 (3rd day)
12.30 am 100.6 120 30
2.30 am 88.6 112 26
4.30 am 99 100 24
6.00 am 98.2 88 22
8.30 am 99.2 100 24
10.00 am 88.2 100 24
12.00 noon 99 99 24
2 pm 98 86 22
4 pm 97.2 86 22
6 pm 98 86 24
8.00 pm 98 84 22
11.00 pm 99.4 120 24 14 / 7 / 96 (4th
day)
1.00 am 98.8 110 26
4.00 am 98 108 24
6.00 am 99 118 26
8.00 am 99 116 24
DISCUSSION:
On 1st DAY of PNC as there were no
significant complaints patient was kept on placebo. On 2nd day presented
with full blown complaints at local and general level. Diagnosis of fever,
offensive, lochia, abdominal pain following labor, it appears due to mild
puerperal sepsis which is rapidly progressing. This means the
susceptibility is moderate with a few characteristics like rapid progress
of sepsis with restlessness > change of position.
throat burning > warm water
DESIRE: warm water, Thirst- increase
As stated above, group of drugs coming
up, Rhus tox Pyrogen, Baptisia keeping pathology and above concomitants in
the mind out of routinism, Rhus Tox 200 6 hrs. was given.
2nd DAY: 10pm: No change as Fever+,
Tenderness+ Pain etc. SQ.
Totality was revised Temp- Pulse ratio
showed disparity. Also, rapidly with which case progressed. Endometrium
and parametrium affected shows the pace of the disease. These two points
are not covered by Rhus Tox. Hence, Pyrogen was thought of 4 hrly.
3rd day: 11 pm: The drug is registered
as immediate improvement by 75 percent in local and general levels.
Continued the dose as disease activity > 75 percent.
4th day: 10 am: While comparing temp.
char, > shows that disease activity > so placebo was given.
5th day: Response of fever variable,
mild pain + Tenderness variable. It means that the disease activity is
changing 200 is not helping. Hence, 1M single dose given.
CONCLUSIONS:
To handle an infection of such type,
one has to update clinical knowledge and apply it to sensitivity,
susceptibility assessment and drug selection. Also, after 1st / 2nd
prescription one has to keep on updating clinically, sensitivity
susceptibility for proper remedy reaction.
Bombay, India