Fever projr Dengue 202404334

 Diagnosis

DENGUE FEVER WITH THROMBOCYTOPENIA

TYPE -2 DIABETES MELLITUS SINCE 2 YEARS

Case History and Clinical Findings

C/O FEVER SINCE 3 DAYS

HEAD ACHE SINCE 3 DAYS

WEAKNESS SINCE 3 DAYS

SWELLING OF BOTH LOWER LIMBS SINCE 1 WEEK

PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN DEVELOPED FEVER WHICH WAS LOW GRADE PERIODIC,ASSOCIATED WITH CHILLS AND RIGORS

HEAD IS SUDDEN IN ONSET,ASSOCIATED WITH FEVER

NO H/O COUGH ,COLD,VOMOTINGS,DIARRHEA,BLOOD STAINED STOOLS,VOMITINGS

K/C/O DIABETES MELLITUS ON TAB.METFORMIN 500 MG SIONCE 2 YEARS

NO H/O HYPERTENSION,TB,ASTHMA,EPILEPSY

CHRONMIC SMOKER 2-3 (CHUTTA) PER DAY SINCE 20 YEARS

NO H/O SIMILAR COMPLAINTS IN THE PAST

GENERAL EXAMINATION :-

PATIENT WAS CONSCIOUS COHERENT AND COOPERATIVE

NO PALLOR ICTERUS CYANOSIS CLUBBING LYPHADENOPATHY AND EDEMA

VITALS :-

TEMP- AFEBRILE

PULSE RATE- 82 BPM

RR- 16 CPM

BP- 110 / 70 MMHG

GRBS- 98 MG/DL

SYSTEMIC EXAMINATION :-

CVS- S1 S2 HEARED, NO MURMURS

RS - BAE + , NVBS

CNS - NFND

P/A - SOFT NON TENDER , BOWEL SOUNDS PRESENT.

COURSE IN HOSPITAL

55 YEAR MALE ADMITTED WITH ABOVE MENTIONED COMPLAINS.NECESSARY INVESTIGATIONS WERE DONE. REPORTS SHOWED THROMBOCYTOPENIA AND NS1 ANTIGEN POSITIVE. DIAGNOSD AS DENGUE FEVER WITH THROMBOCYTOPENIA. CONSERVATIVELY MANAGED

ON DAY 03 OF ADMISSION PATIENT HAD ONE EPISODE OF HEMOPTYSIS.\

ONE UNIT SDP WAS TRANSFUSED

ON DAY 04 PATIENT HAD NO FEVER SPIKES, NO BLEEDING MANIFESTATIONS.

ON DAY 05 PATIENT IS SYMPTOMATICALLY BETTER, PLATELETS WERE IN INCREASING TRENDS

ON DAY 07 PATIENT IS HEMODYNAMICALLY STABLE AND PLANNED FOR DISCHARGE

Investigation

Name Value Range

COMPLETE URINE EXAMINATION (CUE) 27-01-2024 11:39:PM

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN ++

SUGAR +

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 4-5

EPITHELIAL CELLS 3-4

RED BLOOD CELLS Nil

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nil

HEMOGRAM ON 29/1/24

HAEMOGLOBIN # 16.1 gm/dl 12.0 - 15.0

TOTAL COUNT 10,00 cells/cumm 4000 - 10000

NEUTROPHILS 70 % 40 - 80

LYMPHOCYTES # 16 % 20 - 40

EOSINOPHILS 01 % 01 - 06

MONOCYTES # 13 %

BASOPHILS 00 % 0 -

PCV # 23.3 vol % 36 -

M C V 90.7 fl 83 - 101

M C H 31.1 pg 27 - 32

02 - 10

2

46

M C H C 34.3 % 31.5 - 34.5

RDW-CV # 15.1 % 11.6 - 14.0

RDW-SD 50.4 fl 39.0-46.0

RBC COUNT # 2.57 millions/cumm 3.8 - 4.8

PLATELET COUNT 22,000 /cu.mm 1.5-4.1

RBC Normocytic normochromic

WBC With in normal limits

PLATELETS Adequate in number and distribution

HEMOPARASITES No hemoparasites seen

IMPRESSION Normocytic normochromic anemia

HBA1C 7.5 %

HEMOGRAM ON 31/1/24

HAEMOGLOBIN # 15.1gm/dl 12.0 - 15.0

TOTAL COUNT 9,000 cells/cumm 4000 - 10000

NEUTROPHILS 70 % 40 - 80

LYMPHOCYTES # 16 % 20 - 40

EOSINOPHILS 01 % 01 - 06

MONOCYTES # 13 %

BASOPHILS 00 % 0 -

PCV # 23.3 vol % 36 -

M C V 90.7 fl 83 - 101

M C H 31.1 pg 27 - 32

02 - 10

2

46

M C H C 34.3 % 31.5 - 34.5

RDW-CV # 15.1 % 11.6 - 14.0

RDW-SD 50.4 fl 39.0-46.0

RBC COUNT # 4.39 millions/cumm 3.8 - 4.8

PLATELET COUNT 28,000/cu.mm 1.5-4.1

RBC Normocytic normochromic

WBC With in normal limits

PLATELETS Adequate in number and distribution

HEMOPARASITES No hemoparasites seen

IMPRESSION Normocytic normochromic anemia

HEMOGRAM ON 1/2/24

HAEMOGLOBIN # 14.7 gm/dl 12.0 - 15.0

TOTAL COUNT 7,300 cells/cumm 4000 - 10000

NEUTROPHILS 70 % 40 - 80

LYMPHOCYTES # 16 % 20 - 40

EOSINOPHILS 01 % 01 - 06

MONOCYTES # 13 %

BASOPHILS 00 % 0 -

PCV # 23.3 vol % 36 -

M C V 90.7 fl 83 - 101

M C H 31.1 pg 27 - 32

02 - 10

2

46

M C H C 34.3 % 31.5 - 34.5

RDW-CV # 15.1 % 11.6 - 14.0

RDW-SD 50.4 fl 39.0-46.0

RBC COUNT # 4.26 millions/cumm 3.8 - 4.8

PLATELET COUNT 38,000/cu.mm 1.5-4.1

RBC Normocytic normochromic

WBC With in normal limits

PLATELETS Adequate in number and distribution

HEMOPARASITES No hemoparasites seen

IMPRESSION Normocytic normochromic anemia

HEMOGRAM ON 2/2/24

HAEMOGLOBIN # 15.3 gm/dl 12.0 - 15.0

TOTAL COUNT 7000 cells/cumm 4000 - 10000

NEUTROPHILS 70 % 40 - 80

LYMPHOCYTES # 16 % 20 - 40

EOSINOPHILS 01 % 01 - 06

MONOCYTES # 13 %

BASOPHILS 00 % 0 -

PCV # 23.3 vol % 36 -

M C V 90.7 fl 83 - 101

M C H 31.1 pg 27 - 32

02 - 10

2

46

M C H C 34.3 % 31.5 - 34.5

RDW-CV # 15.1 % 11.6 - 14.0

RDW-SD 50.4 fl 39.0-46.0

RBC COUNT 4.49 millions/cumm 3.8 - 4.8

PLATELET COUNT 45,000/cu.mm 1.5-4.1

RBC Normocytic normochromic

WBC With in normal limits

PLATELETS Adequate in number and distribution

HEMOPARASITES No hemoparasites seen

IMPRESSION Normocytic normochromic anemia

BLOOD UREA 27-01-2024 11:39:PM 32 mg/dl 42-12 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 27-01-2024 11:39:PM

SODIUM 134 mEq/L 145-136 mEq/L

POTASSIUM 3.8 mEq/L 5.1-3.5 mEq/L

CHLORIDE 99 mEq/L 98-107 mEq/L

CALCIUM IONIZED 1.11 mmol/L mmol/L

SERUM CREATININE 27-01-2024 11:39:PM 1.5 mg/dl 1.3-0.9 mg/dl

HBsAg-RAPID 27-01-2024 11:39:PM Negative

Anti HCV Antibodies - RAPID 27-01-2024 11:39:PM Non Reactive

PERIPHERAL SMEAR 28-01-2024 03:09:PM RBC : Normocytic normochromic WBC : With in normal limits with increased monocytes PLATELET : decreased counts on smear

STOOL FOR OCCULT BLOOD 28-01-2024 03:09:PM Negative (-ve)

POST LUNCH BLOOD SUGAR 28-01-2024 07:22:PM 356 mg/dl 140-0 mg/dl

RFT 28-01-2024 10:49:PM

UREA 49 mg/dl 42-12 mg/dl

CREATININE 1.5 mg/dl 1.3-0.9 mg/dl

URIC ACID 4.7 mg/dl 7.2-3.5 mg/dl

CALCIUM 7.3 mg/dl 10.2-8.6 mg/dl

PHOSPHOROUS 2.2 mg/dl 4.5-2.5 mg/dl

SODIUM 137 mEq/L 145-136 mEq/L

POTASSIUM 3.7 mEq/L 5.1-3.5 mEq/L

CHLORIDE 103 mEq/L 98-107 mEq/L

BLOOD UREA 29-01-2024 11:35:PM 43 mg/dl 42-12 mg/dl

SERUM CREATININE 29-01-2024 11:35:PM 1.4 mg/dl 1.3-0.9 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 29-01-2024 11:35:PM

SODIUM 137 mEq/L 145-136 mEq/L

POTASSIUM 3.5 mEq/L 5.1-3.5 mEq/L

CHLORIDE 103 mEq/L 98-107 mEq/L

CALCIUM IONIZED 1.14 mmol/L mmol/L

BLOOD UREA 01-02-2024 05:35:AM 23 mg/dl 42-12 mg/dl

SERUM CREATININE 01-02-2024 05:35:AM 1.5 mg/dl 1.3-0.9 mg/dl

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 01-02-2024 05:35:AM

SODIUM 141 mEq/L 145-136 mEq/L

POTASSIUM 4.0 mEq/L 5.1-3.5 mEq/L

CHLORIDE 104 mEq/L 98-107 mEq/L

CALCIUM IONIZED 1.22 mmol/L mmol/L

BLOOD GROUP - O POSITIVE

RBS - 243

FBS - 136

PBS - 356

NS 1 ANTIGEN - POSITIVE

IG M - NEGATIVE

IG G NEGATIVE

LDH - 317 IU/L

RETICULOCYTE COUNT 1 %

SERUM IRON 50 MICRO GM /DL

STOOL FOR OCCULT BLOOD :NEGATIVE

APTT :33 SECS

BLEEDING TIME :2 MINS

CLOTTING TIME : 5 MINS

PT 17 SECS

INR 1.2

2D ECHO

MILD TR + WITH PAH;MILD AR+; NO MR

NO RWMA,NO AS/MS,SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION + ,NO PE

USG ABDOMEN AND PELVIS: FINDINGS

E/O FREE FLUID NOTED IN RIGHT PLEURAL SPACE - PLEURAL EFFUSION

FEW SUB CENTIMETRIC CYSTS NOTED IN BILATERAL KIDNEYS

IMPRESSION :

GRADE II FATTY LIVER

GRADE I SPLENOMEGALY

GALL BLADDER WALL EDEMA

RIGHT PLEURAL EFFUSION

ASCITES

BILATERAL GRADE 1 RPD CHANGES

Treatment Given(Enter only Generic Name)

TAB.DOXYCYCLINE 100 MG PO BD FOR 5 DAYS

INJ.NEOMOL 1 G IV SOS

INJ.HUMAN ACTRAPID INSULIN S/C TID

TAB.PAN 40 MG PO OD

TAB.PCM 650 MG PO SOS

TAB.MVT PO OD

TAB.TEMASARTAN 40 MG PO OD

Advice at Discharge

TAB PAN 40 MG PO OD BEFORE BREAKFAST FOR FIVE DAYS

TAB MVT PO OD 0----1----0 FOR 15 DAYS





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