A 24YEAR OLD FEMALE WITH FEVER,THROMBOCYTOPENIA (?DENGUE FEVER)

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case i have seen : 

A 24year old female who is a home maker came with the c/o headache, giddiness,and generalized weakness since 15days
H/o fever on and of since 15days 
Rashes 15days 
No history of bleeding manifestations such as bleeding gums, Malena
No retrobulbar pain 

HISTORY OF PRESENT ILLNESS:
Patient was asymptomatic 15 days back and then she devloped giddiness, headache and she also noticed a rash on thigh and they went to local RMP and got treatment. One week later symptoms were not subsided, on being tested they got to know that their platelet count was low and took ?Herbal medication. Since symptoms were not subsided they visit local hospital. On decreasing trend of platelet count they presented to casualty

PAST HISTORY:
Not a known case of DM,HTN,TB,CAD,CVD,CKD, Epilepsy,
H/o hysterectomy three years back.

PERSONAL HISTORY:
Patient takes mixed diet, adequate sleep,bowel and bladder habits regular and no addictions.

GENERAL EXAMINATION : 
O/E pt is c/c/c 
Pallor +
No Icterus
No Cyanosis
No Clubbing
No Koilonychia
No Lymphadenopathy
No Pedal edema
Spo2-97% 
  
SYSTEMIC EXAMINATION: 
CVS- S1S2 +, No murmurs 
RS-BAE +,NVBS,No added sounds
P/A-Soft,nontender,no organomegaly
CNS-No FND 

INVESTIGATIONS:
Hemogram : Hb-11.8 gm/dl
                       TLC-12,900cells/cumm
                        PLT-10,000 cells/cumm
BGT- B+ve
CXR- 


ECG- 

USG abdomen -

 
Viral serology- Negative
APTT-42sec
PT-20sec
INR-1.4
RFT-Urea-28
        Creatinine-0.6
        UA-2.5
        Ca2+ - 9.4
        Po4-2.4
        Na+ -141
        K+ -3.9
        Cl-103
 LFT-TB-0.46
         DB-0.16
         AST-17
         ALT-13
         ALP-169
         TP- 6.4
         Albumin-4.0
         A/G-1.62    

TREATMENT:
IVF NS ,RL,DNS-1amp of OPTINEURON @75ml/hr
Tab.Pan 40mg po/of
Tab.Zofer 4mg po/sos
Tab.PCM 650mg po/bd
Inj.PCM 1gm IV/SOS if temperature >101F
Watch for bleeding manifestations
Hemogram 12th hrly
Bp/pr/temperature 4th hrly 
GRBS charting 8th hrly
I/O charting
Inj.vit k 10mg /iv/of
Inform sos
Inj.Taxim 1g/iv/bd
Tab.Doxycycline 100mg/po/bd
1SDP transfusion


ON DAY2-No fever spikes,No c/o bleeding manifestations
O/E: Pt is c/c/c 
Afebrile on touch 
Bp-110/70mmhg
PR- 98bpm
CVS-S1S2+
RS-BAE+,NVBS
P/A-Soft,NT,BS+
CNS-No FND

INVESTIGATIONS:
Hemogram-Hb-11.8
                      TLC-11000
                       PLT- 16000
PT-16sec
APTT-32sec
INR-1.11
BT-2mins
CT-4mins 30sec

TREATMENT:
IVF NS ,RL,DNS-1amp of OPTINEURON @75ml/hr
Tab.Pan 40mg po/of
Tab.Zofer 4mg po/sos
Tab.PCM 650mg po/bd
Inj.PCM 1gm IV/SOS if temperature >101F
Watch for bleeding manifestations
Hemogram 12th hrly
Bp/pr/temperature 4th hrly 
GRBS charting 8th hrly
I/O charting
Inj.vit k 10mg /iv/of
Inform sos
Inj.Taxim 1g/iv/bd
Tab.Doxycycline 100mg/po/bd


ON DAY3--No fever spikes,No c/o bleeding manifestations
O/E: Pt is c/c/c 
Afebrile on touch 
Bp-110/70mmhg
PR- 98bpm
CVS-S1S2+
RS-BAE+,NVBS
P/A-Soft,NT,BS+
CNS-No FND

INVESTIGATIONS:
Hemogram-Hb-11.6
                      TLC-10,000
                       PLT- 26,000

TREATMENT:
IVF NS ,RL,DNS-1amp of OPTINEURON @75ml/hr
Tab.Pan 40mg po/of
Tab.Zofer 4mg po/sos
Tab.PCM 500mg po/bd
Inj.PCM 1gm IV/SOS if temperature >101F
Watch for bleeding manifestations
Hemogram 12th hrly
Bp/pr/temperature 4th hrly 
GRBS charting 8th hrly
I/O charting
Inj.vit k 10mg /iv/of
Inform sos
Inj.Taxim 1g/iv/bd
Tab.Doxycycline 100mg/po/bd


ON DAY4--No fever spikes,No c/o bleeding manifestations
O/E: Pt is c/c/c 
Afebrile on touch 
Bp-130/90mmhg
PR- 82bpm
CVS-S1S2+
RS-BAE+,NVBS
P/A-Soft,NT,BS+
CNS-No FND

INVESTIGATIONS:
Hemogram-Hb-11.5
                      TLC-10,100
                       PLT- 28,000

TREATMENT:
IVF NS ,RL,DNS-1amp of OPTINEURON @75ml/hr
Tab.Pan 40mg po/of
Tab.Zofer 4mg po/sos
Tab.PCM 500mg po/bd
Inj.PCM 1gm IV/SOS if temperature >101F
Watch for bleeding manifestations
Hemogram 12th hrly
Bp/pr/temperature 4th hrly 
GRBS charting 8th hrly
I/O charting
Inj.vit k 10mg /iv/of
Inform sos
Inj.Taxim 1g/iv/bd
Tab.Doxycycline 100mg/po/bd
1SDP transfusion


ON DAY5--No fever spikes,No c/o bleeding manifestations
O/E: Pt is c/c/c 
Afebrile on touch 
Bp-120/80mmhg
PR- 98bpm
GRBS-135mg/dl
CVS-S1S2+
RS-BAE+,NVBS
P/A-Soft,NT,BS+
CNS-No FND

INVESTIGATIONS:
Hemogram-Hb-11.6
                      TLC-10,000
                       PLT- 1.8 lakhs/cumm

TREATMENT:
IVF NS -1amp of OPTINEURON @75ml/hr
Tab.Pan 40mg po/of
Tab.Zofer 4mg po/sos
Tab.PCM 500mg po/bd
Inj.PCM 1gm IV/SOS if temperature >101F
Watch for bleeding manifestations
Hemogram 12th hrly
Bp/pr/temperature 4th hrly 
GRBS charting 8th hrly
I/O charting

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