22 year old male with NS1 antigen+ with thrombocytopenia
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A 22yr old male student came to casualty with complaint of fever since 7days and vomitings 2 episodes since yesterday
Patient was apparently asymptomatic 7days back, then complained of fever which was insidious in onset, continuous type with no diurnal variations and associated with vomiting 2 episodes , 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 he went to a local hospital and his fever has got subsided by treatment,
he has h/o malena since 5 days
No h/o bleeding gums, petechaie, rash, headache.
He 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
On examination, patient is conscious, coherent, cooperative.
No pallor, icterus, cyanosis, clubbing, kylonychia, lymphadenopathy and oedema
VITALS :
Temp - 98.7°F
BP - 120/80 mmHg
PR - 82 bpm
RR - 17 cpm
SpO2 - 97% at RA
GRBS - 194 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-
On 19-08-2021
Hemogram-
HB-15.6
TLC-4850
Neutro-1.55
Lympho-2.86
Eosino-0.10
Monocytes-0.31
Basophills- 0
PCV-43.5
RBC-5.30
PLT-45000
CUE-
Albumin-+
Pus cells-3-4
Epithelial cells-2-3
Sugars-nil
BGT- O+
PT- 15 sec
APTT- 31 sec
INR- 1.11
Stool for occult blood- negative
LFT-
TB-1.48
DB-0.28
AST-194
ALT-169
ALP-205
RFT-
Blood urea-23
Sr.creat-0.6
Na-135
K- 4.1
Cl- 92
Serology- negative
X ray-
USG-
ECG-
On 20-08-2021; 8:00am
Hemogram
HB-14.4
TLC-6100
Neutro-20
Lympho-70
Eosino-1
Monocytes-9
Basophills- 0
PCV-39.3
RBC-4.83
PLT- 15000
On 20-08-2021; 10:00pm
After SDP TRANSFUSION:-
Hemogram
HB-13.3
TLC- 6100
Neutro- 20
Lympho- 70
Eosino- 01
Monocytes- 09
Basophills- 0
PCV-39.8
RBC-4.47millons/ cumm
PLT- 1.5 lakh/cu.mm
On 21-08-2021
Hemogram-
HB-14.1
TLC-9300
Neutro- 20
Lympho- 71
Eosino- 8
Monocytes-1
Basophills- 0
PCV- 39.3
RBC-4.76
PLT- 1.3
Rx-
On Day 0-
1) IV fluids- 2NS,2RL,2DNS
2) INJ.ZOFER 4 mg PO SOS
3) INJ.PAN 40 mg PO OD
4) INJ.NEOMOL 1gm IV SOS if temp>101°F
5) TAB.DOLO 650 mg po bd
6) Temp charting 4 hrly
7) BP charting 4th hrly
Day 1-
1) IV fluids- 2NS,2RL,2DNS
2) INJ.ZOFER 4 mg PO SOS
3) INJ.PAN 40 mg PO OD
4) INJ.NEOMOL 1gm IV SOS if temp>101°F
5) TAB.PCM 650 mg po bd
6) Temp charting 4th hrly
7) BP charting 4th hrly
DAY 2-
1) IV fluids- 2NS,2RL,2DNS
2) TAB.ZOFER 4 mg PO SOS
3) TAB.PAN 40 mg PO OD
4) TAB.PCM 650 mg po bd
5) Temp charting 4th hrly
6) BP charting 4th hrly
