20 year female with Fever and thrombocytopenia with NS 1 antigen positive

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Case :

A 20 year old female, resident of nalgonda, came to the casualty with the complaints of fever since 5 days.

Patient was apparently asymptomatic 5 days back then she developed fever which is on and off, not associated with chills and rigors and which was subsided on taking medication. And there is h/o vomiting (1episode), which is non bilious, non projectile, food as a content.

She had h/o melena passage ( black coloured stools) since 2days.

No h/o other bleeding manifestations, bleeding gums, hematemesis, hemoptysis.

On examination 

Patient C/C/C

No Pallor, icterus, cynaosis, clubbing, lymphadenopathy, edema 

VITALS 

BP - 120/80 mmhg

PR - 70bpm

RR - 16 cpm

SpO2 - 98% at RA 

GRBS -102 mg/dl

CVS -  S1 S2 heard 

RS - BAE +, NVBS heard 

CNS - NFND 

P/A - Soft and non tender

Bowel sounds are heard

Provisional diagnosis:

Fever with thrombocytopenia ( NS1 positive )

Investigation:

Hemogram:

Hb - 12.6

TLC - 4000

Platelets - 1lakh

PCV - 41.6

CUE :

Albumin - NIL 

Sugar - NIL 

Pus cells - 3-4 

RBC - NIL 

RFT :

Urea - 14

Creatinine - 0.8

Na - 140

K - 5.4

Cl - 99

LFT :

TB - 0.68

DB - 0.18

AST - 39

ALT - 11

ALP - 110

TP - 6.1

ALB - 3.5

ABG :

pH - 7.41

pCO2 - 26.9

pO2 - 86.9

HCO3 - 16.8

HCO3 st - 19.3

Serology ( HIV, HbsAg, HCV ) - negative 

Rapid Dengue profile - 

 NS 1 antigen- postive 

 IgM - negative 

 IgG - negative 

Stool for occult blood - NEGATIVE 

Blood grouping and typing - O positive 

Bleeding time - 2min

Clotting time - 5 min

ECG 

Chest X ray PA view 

USG Abdomen

Fever charting :

Treatment :

Day 0 

- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 1

S:
No Fever
Malena present 

O :
Pt C/C/C
Temp - 98 F
BP - 110/70 mmHg
PR - 82 bpm
RR - 16 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 90000 

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 2
S:
No Fever
No malena 

O :
Pt C/C/C
Temp - 98.5 F
BP - 120/80 mmHg
PR - 80 bpm
RR - 17 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 1 lakh 

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 3 

S:
No Fever
No new complaints

O :
Pt C/C/C
Temp - 98 F
BP - 120/80 mmHg
PR - 76 bpm
RR - 16 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 1.45 lakhs 

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 4
S:
No Fever
No new complaints

O :
Pt C/C/C
Temp - 97.5 F
BP - 110/80 mmHg
PR - 80 bpm
RR - 17 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 1.77 lakh 

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS