20 yr old female with NS 1 antigen positive
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CASE :
Patient was apparently asymptomatic 5days back, then complainted of fever which was insidious in onset, continuous type with no diurnal variations and associated with vomiting 2-3 episodes per day, non bilious with food particles as content, non projectile.
Patient also has generalized weakness and complaint of abdominal discomfort in epigastric region and left hypochondrium since 5days.
For which she went to a local hospital and her fever has got subsided by treatment,
No h/o bleeding gums, malena, petechaie, rash, headache.
She was referred to our hospital in view of low platelet count (28,000/cumm)
Patient is not a k/c/o diabetes, hypertension, asthma, tuberculosis, epilepsy and CAD
Patient has mixed diet with normal appetite and has regular bowel and bladder habits with no known allergies and has no addicitons
Menstrual history:
She attainted menarche at 17yrs of age, with regular cycles for every 28days with 5 days of flow not associated with pain and clots
On examination, patient is conscious, coherent, cooperative.
No pallor, icterus, cyanosis, clubbing, kylonychia, lymphadenopathy and oedema
VITALS :
Temp - 98.4 F
BP - 100/80 mmHg
PR - 89 bpm
RR - 16 cpm
SpO2 - 98 % at RA
GRBS - 147 mg/dL
On systemic examination
CVS - S1, S2 heard, No murmurs
RS - Bilateral air entry present, with normal vesicular breath sounds heard
Per Abdomen - soft, No organomegaly, Bowel sounds heard
CNS - NAD
PROVISIONAL DIAGNOSIS:
Dengue fever ( NS1 positive ) with thrombocytopenia
Investigations :
Hemogram :
Hemoglobin - 13.6 gm/dl
Total count - 4400 cells/cumm
Neutro - 41
Lympho - 51
Eosino - 1
Mono - 7
Baso - 0
PCV - 39.7
RBC Count - 4.91 millions/cumm
Platelet count - 19000/cumm (d)
Complete urine examination :
Acidic
Albumin - trace
Sugar - nil
Pus cells - 2-3
Red blood cells - nil
Cast - nil
Crystal- nil
Blood grouping and typing : O positive
APTT : 33 sec
PT : 16sec
INR : 1.11
Random blood sugar : 101 mg/dl
Renal function test
Sr. Creatinine - 0.7 mg/dl
Sr. Urea - 14 mg/dl
Sr. Na - 138 mEq/L
Sr. K - 4.3 mEq/L
Sr. Cl - 97 mEq/L (D)
Liver function test :
Total bilirubin - 1 mg/dl
Direct bilirubin - 0.18 mg/dl
AST - 173 IU/L (I)
AST - 70 IU/L (I)
ALP - 219 IU/L (I)
TOTAL PROTEIN - 5.6 gm/dl (D)
Albumin - 3 gm/dl (D)
A/G - 1.19
Serology - ( HIV, HbsAg, HCV ) - negative
Chest X ray PA view :
ECG :
Ultrasound abdomen :
2D ECHO :
Fever charting :
Treatment :
Day 0
- IV Fluids 2 NS , 2 RL, 1 DNS at 75ml/hr
- INJ. PANTOP 40 mg IV/ OD
- INJ. ZOFER 4 mg IV/ BD
- TAB. DOLO 650 mg PO/ SOS
- INJ. NEOMOL 1gm / IV / SOS ( if temp >101 F )
Day 1
No fever spikes, no bleeding manifestations ( hematemesis, malena, bleeding gums )
Vitals
Temp - 98 F
BP - 100/60 mmhg
PR - 80 bpm
RR - 16 cpm
SpO2 - 99% at RA
GRBS - 140 mg/dl
Input - 1900 ml
Output - 1000 ml
CVS - S1 S2 heard
RS - BAE present, NVBS heard
Per Abdomen- soft, BS heard
CNS - NAD
Investigations:
Hb - 12.7
TLC - 5000
RBC - 4.94
PLT - 39000
Treatment given
- IV Fluids 2 NS , 2 RL at 75ml/hr
- INJ. PANTOP 40 MG IV/ OD
- INJ. ZOFER 4MG IV/ BD
- TAB. PCM 650MG PO/ SOS
- Thrombrophobe Ointment for local application
Day 2
No fever spikes,
C/o cough
Vitals
Temp - 98.5 F
BP - 100/70 mmhg
PR - 86 bpm
RR - 14 cpm
SpO2 - 99% at RA
GRBS - 93 mg/dl
CVS - S1 S2 heard
RS - BAE present, NVBS heard
Per Abdomen- soft, BS heard
CNS - NAD
Investigations:
Hb - 11.9
RBC - 4.29
PLT - 39000
TLC - 4000
TB - 1.06
DB- 0.3
AST - 194
ALT - 68
ALP - 190
TP - 5.9
ALB - 2.9
Treatment given
- IV Fluids 2 NS , 2 RL at 75ml/hr
- INJ. PANTOP 40 MG IV/ OD
- INJ. ZOFER 4MG IV/ BD
- TAB. PCM 650MG PO/ SOS
- SYP. ASCORIL-LS PO SOS
- SYP. MUCAINE GEL PO BD
- Thrombrophobe Ointment for local application
Treatment given
- IV Fluids 2 NS , 2 RL at 75ml/hr
- INJ. PANTOP 40 MG IV/ OD
- INJ. ZOFER 4MG IV/ BD
- TAB. PCM 650MG PO/ SOS
- SYP. ASCORIL-LS PO SOS
- SYP. MUCAINE GEL PO BD
- Thrombrophobe Ointment for local application
Day 3
No fever spikes,
Cough decreased
Vitals
Temp - 98.5 F
BP - 110/70 mmhg
PR - 86 bpm
RR - 15 cpm
SpO2 - 99% at RA
GRBS - 106 mg/dl
CVS - S1 S2 heard
RS - BAE present, NVBS heard
Per Abdomen- soft, BS heard
CNS - NAD
Investigations:
Hb - 11.6
RBC - 4.17
PLT - 60000
TLC - 3500
Treatment given
- IV Fluids 2 NS , 2 RL at 75ml/hr
- INJ. PANTOP 40 MG IV/ OD
- INJ. ZOFER 4MG IV/ BD
- TAB. PCM 650MG PO/ SOS
- SYP. ASCORIL-LS PO SOS
- SYP. MUCAINE GEL PO BD
- Thrombrophobe Ointment for local application
No fever spikes,
Cough decreased
Vitals
Temp - 98.5 F
BP - 110/70 mmhg
PR - 86 bpm
RR - 15 cpm
SpO2 - 99% at RA
GRBS - 106 mg/dl
CVS - S1 S2 heard
RS - BAE present, NVBS heard
Per Abdomen- soft, BS heard
CNS - NAD
Investigations:
Hb - 11.6
RBC - 4.17
PLT - 60000
TLC - 3500
Treatment given
- IV Fluids 2 NS , 2 RL at 75ml/hr
- INJ. PANTOP 40 MG IV/ OD
- INJ. ZOFER 4MG IV/ BD
- TAB. PCM 650MG PO/ SOS
- SYP. ASCORIL-LS PO SOS
- SYP. MUCAINE GEL PO BD
- Thrombrophobe Ointment for local application
Day 4
No fever spikes,
No new complaints
Vitals
Temp - 98.5 F
BP - 120/70 mmhg
PR - 88 bpm
RR - 16 cpm
SpO2 - 99% at RA
GRBS - 106 g/dl
CVS - S1 S2 heard
RS - BAE present, NVBS heard
Per Abdomen- soft, BS heard
CNS - NAD
Investigations:
Hb - 11.4
RBC - 4.11
PLT - 120000
TLC - 4000
Treatment given
- Plenty of oral fluids
- INJ. PANTOP 40 MG IV/ OD
- INJ. ZOFER 4MG IV/ BD
- TAB. PCM 650MG PO/ SOS
- SYP. ASCORIL-LS PO SOS
- SYP. MUCAINE GEL PO BD
- Thrombrophobe Ointment for local application
No fever spikes,
No new complaints
Vitals
Temp - 98.5 F
BP - 120/70 mmhg
PR - 88 bpm
RR - 16 cpm
SpO2 - 99% at RA
GRBS - 106 g/dl
CVS - S1 S2 heard
RS - BAE present, NVBS heard
Per Abdomen- soft, BS heard
CNS - NAD
Investigations:
Hb - 11.4
RBC - 4.11
PLT - 120000
TLC - 4000
Treatment given
- Plenty of oral fluids
- INJ. PANTOP 40 MG IV/ OD
- INJ. ZOFER 4MG IV/ BD
- TAB. PCM 650MG PO/ SOS
- SYP. ASCORIL-LS PO SOS
- SYP. MUCAINE GEL PO BD
- Thrombrophobe Ointment for local application
Course in the hospital :
A 20year old female, student, came to casualty with complaint of fever since 5 days and vomitings since 5 days
Patient was apparently asymptomatic 5days back, then complainted of fever which was insidious in onset, continuous type with no diurnal variations and associated with vomiting 2-3 episodes per day, non bilious with food particles as content, non projectile.
Patient also has generalized weakness and complaint of abdominal discomfort in epigastric region and left hypochondrium since 5days.
For which she went to a local hospital and her fever has got subsided by treatment,
No h/o bleeding gums, malena, petechaie, rash, headache.
She was referred to our hospital in view of low platelet count (28,000/cumm)
Here we managed the patient conservatively with iv fluids, anti emetic and antipyretics. She complainted of cough for which she was given Syrup ascoril during the stay in hospital.
As the platelet count has improved from 19000 to 1.20 lakh, patient was discharged with medication and adviced for follow up after 1 week
Advice at discharge :
- Plenty of oral fluids
- TAB. ZINCOVIT / PO/OD for 15 days
- TAB. DOLO 650mg/PO/SOS
