Sahar Haider10 months ago

Case for disscusion : 19yrs old male presented with fever for one day high grade not associated with rigor or convulsion On ex: HR:46 BP low about 90/60 High temp38 BFFm positive Hb 12 g/dl WBC8.6 RBS 126 S.electrolytes +RFT :normal Serum cortisol :258 N(15- 225 ) Received 3 L of normal saline not response then add noradrenaline Quinine drip Meropenium inj Patient admitted to ICU now on day 9 still on noradrenaline Note:the patient has sleeping brady cardia reach to 43 And Bp become more low when sleep with the same rate of noreadrenaline when the patient awke ,MAP49 diastole 43---39 Differntiol doagnosis ?