Dengue 2

A 14 yr old male student came with chief complaints of 

 Fever since 5 days 

Vomitings since 3 days 

Pain abdomen since 3 days 


HOPI: pt is apparently asymptomatic 5 days back then he developed fever lowgrade,intermittent, not associated with chills and rigors ,rash, loose stools,relieved on taking medication 

-Vomitings since 3 days non projectile, non bilious, food as content  , 1-2 episodes per day 

-Pain abdomen since 3 days relieved on sleeping and aggrevating by sitting 

- He went to local hospital yesterday and tested NS1 positive and referred to our hospital in view of  platelet count 52,000 and moderate ascites


PAST HISTORY : 

No past medical history 


PERSONAL HISTORY: mixed diet , decreased appetite,regular bowel and bladder, sleep adequate no addictions 


FAMILY HISTORY:not significant 


GENERAL EXAMINATION: 

Pt is c,c,c 

Afebrile 

Bp : supine 90/60 

        Standing 80/60 

PR :72 

Rr:20 

PA : tenderness present in periumblical region

        Shifting dullness present 

Cvs:s1s2 heard 

Cns :NAD 

RS:bilateral air entry present 


Provisional diagnosis: VIRAL PYREXIA WITH THROMBOCYTOPENIA ( DENGUE NS1 positive ) 


Investigations 

On 25/08/2021 

 Hemogram 

    HB: 14.6

    Tlc:6700

    Platelets: 90,000

    Pcv 41.6

RBS: 100mg/dl

Sr urea:27

Sr creat: 0.6

Na+ : 135

K+:4.2

Cl- 102


LFT

    TB: 0.83

     Db: 0.2

     AST: 276

     ALT : 125

    ALP : 216

    TP: 5.5

    Albumin: 3.4

    A/G : 1.66

 

On 26/08/2021 

@ 6:00 am 

Hb :13.4

Tlc: 4300

Platelets:40000


6:00pm


Hb :12.4
Tlc: 3500

Platelets:60000


On 27/08/2021 



On 28/08/2021 


Hb :13.1
Tlc: 3000
Platelets:1.8 lakh


Treatment

On 25/08/2021 

  • IVF NS,RL@100ml/hr
  • Tab DOLO650mg /po/ tid 
  • Inj NEOMAL 1 gm /iv/ sos
  • Inj. PAN 40mg /iv/od 
  • Temp charting 2 nd hrly 
  • Strict I/O charting 


On 26/08/2021 

DAY 2 


Subjective :

Pain abdomen present 

Petechia present on left side of sternum 

Vomitings resolved 

No fever spikes 



Objective :

Afebrile

Bp: supine 90/60

       Standing :80/60

PR: 78

PA : tenderness present in periumblical area 

        Shifting dullness present 


ASSESSMENT:

Hb :13.4

Tlc: 4300

Platelets:40000


VIRAL PYREXIA WITH THROMBOCYTOPENIA (DENGUE NS1 positive 

PLAN OF TREATMENT :

  • IVF NS,RL@100ml/hr
  • Tab DOLO650mg /po/ tid 
  • Inj NEOMAL 1 gm /iv/ sos
  • Inj. PAN 40mg /iv/od 
  • Temp charting 2 nd hrly 
  • Strict I/O charting 

On 27/08/2021 
Soap notes 
Day 3 

Subjective :
Petechia present on left side of sternum 
No fever spikes 

Objective :
Afebrile
Bp: supine 100/70 mmHg
       Standing :90/70
PR: 80 bpm.

ASSESSMENT:
Hb :12.8
Tlc: 3200
Platelets:92000

VIRAL PYREXIA WITH THROMBOCYTOPENIA (DENGUE NS1 positive ) 

PLAN OF TREATMENT :
- IVF NS,RL@100ml/hr
- Tab DOLO650mg /po/ tid 
- Inj NEOMAL 1 gm /iv/ sos
- Inj. PAN 40mg /iv/od 
- Temp charting 2 nd hrly 
- Strict I/O charting

On 28/08/2021
Soap notes 
Day4

Subjective :
No fever spikes 

Objective :
Afebrile
Bp: supine 110/70 mmHg
       Standing :100/70
       PR: 74 bpm.
ASSESSMENT:
Hb :13.1
Tlc: 3000
Platelets:1.8 lakh

VIRAL PYREXIA WITH THROMBOCYTOPENIA (DENGUE NS1 positive ) 

PLAN OF TREATMENT :
- IVF NS,RL@100ml/hr
- - Tab DOLO650mg /po/ tid 
- Inj NEOMAL 1 gm /iv/ sos
- - Inj. PAN 40mg /iv/od 
- Temp charting 2 nd hrly 
- - Strict I/O charting





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