42 M with fever,headache,joint pains since 4 days ,shortness of breath since 1 day,burning micturition since 3 days and dark colored stools since 2 days


 



42 year old  male who is a mechanic by occupation 

Came with complaints of fever  head ache and joint pains since 4 days.

 He has Shortness of breath since 1 day - (grade 2 SOB).

 burning micturition since 3 days.

Dark colored stools since 2 days

History of present illness: patient was apparently all right 4 days back then he had complaints of

Fever since 4 days, 

Myalgias since 4 days

Headache since 4 days in bilateral frontal region,throbbing,aggravated on coughing.

Not associated with photophobia or phonophobia

Complaints of burning micturition since 3 days, not associated with hematuria,or decreased urine output

Complaints of dark colored stools since 2 days

Complaints of SOB grade 2 not associated with chest pain,palpitations,sweating.

History of past illness:

Not a k/C/O HTN,DM,EPILEPSY,asthama,TB,CVD,CAD

Occasional alcoholic,non smoker


General examination:


Patient is conscious,coherent,cooperative.

Well built and well nourished

No pallor,icterus,cyanosis,clubbing,pedal edema or lymphadenopathy.








Vitals:

Temperature:99F

Pulse:100/min

RR:100/min

Bp:100/60 mm hg, no postural hypotension.

Spo2:99% at RA




Systemic examination:


CVS:S1 S2 heard, no abnormal sounds

RS: NVBS,no additional sounds

Abdomen: scaphoid,no tenderness,no palpable masses.

CNS-NAD

Provisional diagnosis: Dengue fever,NS+

Fever under evaluation with thrombocytopenia.

Platelet counts- 20,000 outside(23/12/20)

9,000 (24/12/20 at 8:00 pm)

7,000(today morning)

38,000 after transfusion at 6:30 pm today

Stool for occult blood-positive



Treatment:


Day1:


Iv fluids NS,RL@125 ml/hr continuous infusion

Inj.pan 40mg IV/BD

BP Monitoring 2nd hourly

Tab.PCM 500 mg/PO/TID

Temp charting 

Watch for bleeding manifestations 

Hemogram 12th hourly 

Syrup.Ascoryl-D 10ml PO BD


Day2:


Iv fluids NS,RL@100ml/hr continuous infusion

Inj.pan 40mg IV/BD

BP Monitoring 2nd hourly

Tab.PCM 500 mg/PO/TID

Temp charting 

Watch for bleeding manifestations 

Hemogram 12th hourly 

Syrup.Ascoryl-D 10ml PO BD


Day3:


Iv fluids NS,RL@100ml/hr continuous infusion

Tab.Doxycycline 100mg/PO/BD

Inj.pan 40mg IV/BD

Inj.Neomol 100ml/IV/SOS If temp >101F

BP Monitoring 2nd hourly

Tab.PCM 500 mg/PO/TID

Temp charting 

Watch for bleeding manifestations 

Hemogram 12th hourly 

Syrup.Ascoryl-D 10ml PO BD


Day4:


Iv fluids: NS,DNS,RL@ 100ml/hr

Tab.doxycycline 100mg/PO/BD

Tab.dolo 650 mg/PO/TID

Inj.Neomol 100ml/IV/SOS if temp >101F

Inj.Pantop 40mg/IV/BD

Syrup.Sucralfate 10ml/PO/TID

Syrup.Ascoryl -D 10ml/PO/TID

Watch for bleeding manifestations(bleeding gums and dark colored stools)

Hemogram 12th hourly


X ray:


Ecg




Stool for oocult blood





Hemogram on day 1:



Hemogram on day 2:



Hemogram on day 2 after transfusion:



Hemogram on day3:



LFT



RFT



Malarial parasite 



CUE




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