A 25 year old female with fever and petechiae

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A 25 year old female came to the opd with cheif complaints of

 Fever since 3 days

Loose stools since morning - (5-6 times) 

Vomitings since morning (3 episodes) 

HOPI :

Patient was apparently asymptomatic 3 days ago then she developed fever which was insidious in onset  gradually progressive high grade. No aggravating and relieving factors. Passage of loose stools , watery since 1 day and vomiting since 1 day which is non projectile, non blood stained, food as content, non bilious. She also complaints of body pains since 1  week. 

No pedal edema , increase or decrease in urine output,  no abdominal pain, no retro orbital pain. 

PAST HISTORY 

She is not a known case of diabetes, hypertension,asthma,cad,epilepsy

★PERSONAL HISTORY 

Diet-mixed 

APETITE - normal

Sleep-adequate 

Bowel and bladder movements -normal

Addictions -none 

MENSTRUAL HISTORY 

Age of menarche -13 years

Cycles- regular 3/28

Pads used per day -3

Bleeding,clotting- absent 

GENERAL EXAMINATION

The patient is conscious coherent cooperative well oriented to time place and person 

She is moderately built and nourished 

Pallor - absent 

Icterus -absent 

Cyanosis-absent 

Clubbing -absent 

Edema -absent 

Lymphadenopathy -absent 

 VITALS 

Temp-99F

BP-100/80 mm of hg

RR-21

PR - 82

Spo2 -98

GRBS -203

★SYSTEMIC EXAMINATION 

CVS:

• S1, S2 heard

• No thrills and cardiac murmurs

RESPIRATORY SYSTEM:

• No dyspnoea, wheezing

• Postion of trachea - central

• Breath sounds - Vesicular

ABDOMEN:

• Shape  : flat

•  tenderness present, palpable mass, bruits

• No palpable liver and spleen

CNS:

• Conscious and coherent

• Speech - normal 

No signs of meningeal irritation

Provisional diagnosis:

Dengue with ns1 positive

CBP

Hb - 15.6 g/dl

Platelets- 56,000 

TLC- 2130 

MCV - 82

Blood Group - AB+ve

Serology

NS1 antigen - Positive

IgM - Negative

IgG - Negative

Serum Urea - 26 mg/dl

Creatinine - 0.7 mg/dl

LFT

SGOT - 96

SGPT - 71

ALP - 191

Total Protein - 8.1 mg/dl

Albumin - 4.4 mg/dl

A/G-1.21

Serum Electrolytes

Na+ - 135 

K+ - 5.3

Cl- - 98

PT- 17

INR - 1.2

APTT - 39 

USG Abdomen

ECG

TREATMENT

28/11/23

1. IV fluids NS @75 ml/hr

2. Tab. Doxycycline 100mg PO/BD

3. Inj. Optineuron 1 amp in 100 ml NS IV OD

4. Temperature 4th hourly

5. BP monitoring 2nd hourly

6. Inj. Zofer 4mg IV BD

7. Inj. Pan 40 mg OD

8. 1 ORS sachet in 1 l water

9. 200 ml ORS after each episode of loose stools
   

29/11/23

1. IV fluids NS @200 ml/hr

2. Tab. Doxycycline 100mg PO/BD

3. Inj. Optineuron 1 amp in 100 ml NS IV OD

4. Temperature 4th hourly

5. BP monitoring 2nd hourly

6. Inj. Zofer 4mg IV BD

7. Inj. Pan 40 mg OD

8. 1 ORS sachet in 1 l water

9. Inj. PCM 1 gm IV if temp > 101F