Dengue

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VIRAL PYREXIA WITH THROMBOCYTOPENIA
(Dengue)

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.

A 46 y F presented at  casualty with h/o fever since 5days a/w giddiness, vomiting since 5 days (2-3 episodes/day),loss of appetite present , no h/o bleeding gums,bleeding per  rectum, malena ,  hematemesis 
HOPI 
Pr was apparently asymptotic 5 days back , then he developed fever , which is sudden in onset & associated with chills and rigors
Not relieved on medication.
vomiting since 5 days (2-3 episodes/day)- non bilious , non projectile , content -food . 
- no c/o chest pain , palpitations , syncopal attack.
- no c/o orthoptera , PND
- no c/o pedal edema decreased urine output.
PAST HISTORY 
NO H/O OF DIABETES, HTN, SEIZURES , CAD, CVA,THYROID
No significant family history
Menstrual History : not significant
Personal History:
Diet: Mixed 
Appetite: Normal
B & B: Regular
Sleep: Adequate
NO Addictions
No significant treatment history

On GENERAL PHYSICAL EXAMINATION
 Pt is c/c/c , Moderately built And Nourished.
No Signs of Pallor , icterus,  cyanosis, clubbing, lymphadenopathy,  Pedal Edema.
febrile- 101F ,
bp-80/45 , 
pr-100
RR-21
Sp02:99% at RA.
SYSTEMIC EXAMINATION 
CARDIOVASCULAR SYSTEM:
Inspection:
Chest wall is bilaterally symmetrical.
No precordial bulge
No visible pulsations, engorged veins, scars, sinuses

Palpation:
JVP: normal
Apex beat: felt in the left 5th intercostal space in the mid clavicular line.

Auscutation:
S1, S2 heard , No murmurs

RESPIRATORY SYSTEM-
Position of trachea: central
Bilateral air entry +
Normal vesicular breath sounds - heard
No added sounds.

PER ABDOMEN:
Abdomen - Tenderness + at umbelical region
No organomegaly.
Bowel sounds heard.
No palpable mass or free fluid 

PROVISIONAL DIAGNOSIS -VIRAL PYREXIA WITH THROMBOCYTOPENIA

TREATMENT
DAY 1
1. Intra venous fluids - NS, RL, DNS @ 100ml/hr
2. Inj OPTINEURON 1 Ampule in 100ml NS/IV/OD
3. Inj NEOMOL 1gm/IV/SOS
4. Inj PAN 40 mg IV/OD
5. Inj ZOFER 4mg/IV/TID
6. Tab DOLO 650mg PO/BD
7. Monitor vitals
8. Watch for bleeding manifestations

Day 2
1. Intra venous fluids - NS, RL, DNS @ 100ml/hr
2. Inj OPTINEURON 1 Ampule in 100ml NS/IV/OD
3. Inj NEOMOL 1gm/IV/SOS
4. Inj PAN 40 mg IV/OD
5. Inj ZOFER 4mg/IV/TID
6. Tab DOLO 650mg PO/BD
7. Monitor vitals
8. Watch for bleeding manifestations

Day 3
1. Intra venous fluids - NS, RL, DNS @ 100ml/hr
2. Inj OPTINEURON 1 Ampule in 100ml NS/IV/OD
3. Inj NEOMOL 1gm/IV/SOS
4. Inj PAN 40 mg IV/OD
5. Inj ZOFER 4mg/IV/TID
6. Tab DOLO 650mg PO/BD
7. Monitor vitals
8. Watch for bleeding manifestations

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