fever projr dengue 202415266 35/f

 Diagnosis

VIRAL PYREXIA WITH THROMBOCYTOPENIA (RESOLVING)

ACUTE GE (RESOLVED)

ORAL CANDIDIASIS

S/P 2 SDP TRANSFUSIONS ON 6/4/24 , 8/4/24

Case History and Clinical Findings

A 35Y/F CAME WITH C/O FEVER SINCE 3DAYS , LOOSE MOTIONS AND VOMITINGS SINCE 3 DAYS

PT. WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO , THEN SHE DEVELOPED FEVER , WHICH WAS INSIDIOUS IN ONSET , HIGH GRADE , INTERMITTENT A/W CHILLS RESOLVED ON MEDICATION

H/O VOMITINGS 5-6 EPISODES , FOOD ASSOCIATED , NON-PROJECTILE, NON-BILIOUS

H/O LOOSE STOOLS -3 EPISODES PER DAY , WATERY IN CONSISTENCY

H/O PETECHIAE OVER PALATE , RETRO ORIBITAL PAIN , MELENA , SOB

N/H/O PAIN ABDOMEN

PAST HISTORY

N/K/C/O DM,HTN,ASTHMA,EPILEPSY,THYROID DISORDERS

GENERAL EXAMINATION

PATIENT IS CONSCIOUS COHERENT CO-OPERATIVE

TEMP 98 F

PR 88 BPM

RR 20 CPM

BP 110/70 MMHG

SPO2 98

CVS S1 S2 HEARD NO MURMURS

RS: DYSPNEA: GRADE II TO III NYHA, TRACHEA CENTRAL, VESICULAR BREATH SOUNDS

ABDOMEN: SCAPHOID, SOFT, NON TENDER

CNS: GCS E4V5M6, CONSCIOUS, NORMAL SPEECH

REFLEXES: RIGHT LEFT

BICEPS +2 +2

TRICEPS +2 +2

SUPINATOR + +

KNEE +2 +2

ANKLE + +

COURSE IN THE HOSPITAL

35 Y/F CAME WITH COMPLAINTS OF FEVER SINCE 3 DAYS ,LOOSE STOOLS AND VOMITINHG SINCE 3 DAYS

PATIENT WAS EVALUATED ACCORDINGLY AND FOUND THROMBOCYTOPENIA (PLATELETS - 34K) ,DENGUE SEROLOGY NEGATIVE , SUPPORTIVE TREATMENT WITH IV FLUIDS AND ANTIBIOTICS WAS GIVEN AND L/V/L FURTHER DROP IN PLATELET COUNT SDP TRANFUSIONS WERE DONE ON 6/4/24 AND 8/4/24 .

NO NEW BLEEDING MANIFESTATIONS WERE NOTICED DURING HOSPITAL STAY, PATIENT SYMPTOMS IMPROVED AND PLATELETS COUNTS WERE IMPROVING FROM DAY 9 OF ILLNESS . PATIENT VITALS ARE STABLE AND PLATELET COUNTS ARE 1 LAKH AT THE TIME OF DISCHARGE

Investigation


COMPLETE URINE EXAMINATION (CUE) 04-04-2024 05:20:PM COLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINtraceSUGARNilBILE SALTSNilBILE PIGMENTSNilPUS CELLS3-4EPITHELIAL CELLS2-3RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilBLOOD UREA04- 04-2024 05:20:PM25 mg/dl42-12 mg/dlSERUM CREATININE04-04-2024 05:20:PM1.6 mg/dl1.1-0.6 mg/dlSERUM ELECTROLYTES (Na, K, C l) 04-04-2024 05:20:PM SODIUM140 mmol/L145-136 mmol/LPOTASSIUM4.1 mmol/L5.1-3.5 mmol/LCHLORIDE105 mmol/L98-107 mmol/LLIVER FUNCTION TEST (LFT) 04-04-2024 05:20:PM Total Bilurubin0.56 mg/dl1-0 mg/dlDirect Bilurubin0.16 mg/dl0.2-0.0 mg/dlSGOT(AST)106 IU/L31-0 IU/LSGPT(ALT)39 IU/L34-0 IU/LALKALINE PHOSPHATASE539 IU/L98-42 IU/LTOTAL PROTEINS5.6 gm/dl8.3-6.4 gm/dlALBUMIN3.1 gm/dl5.2- 3.5 gm/dlA/G RATIO1.26HBsAg-RAPID04-04-2024 05:21:PMNegative Anti HCV Antibodies - RAPID04-04-2024 05:21:PMNon Reactive BLOOD UREA05-04-2024 11:40:AM27 mg/dl42-12 mg/dlSERUM CREATININE05-04-2024 11:40:AM1.2 mg/dl1.1-0.6 mg/dlSERUM ELECTROLYTES (Na, K, C l) 05-04-2024 11:40:AM SODIUM132 mmol/L145-136 mmol/LPOTASSIUM3.2 mmol/L5.1- 3.5 mmol/LCHLORIDE106 mmol/L98-107 mmol/LBLOOD UREA06-04-2024 12:57:AM23 mg/dl42-12 mg/dlSERUM CREATININE06-04-2024 12:57:AM1.1 mg/dl1.1-0.6 mg/dlSERUM ELECTROLYTES (Na, K, C l) 06-04-2024 12:57:AM SODIUM145 mmol/L145-136 mmol/LPOTASSIUM3.2 mmol/L5.1- 3.5 mmol/LCHLORIDE106 mmol/L98-107 mmol/L

6/4/2024

PRE-TRANSFUSION HEMOGRAM

HB-11.5 GM/DL

TLC-22,000CELLS/CUMM

NEUTROPHILS : 54%

LYMPHOCYTES : 35%

EOSINOPHILS : 1%

MONOCYTES : 10%

BASOPHILS :0

PLATELET COUNT - 12,000/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC WITH FEW MACROCYTES

POST TRANSFUSION HEMOGRAM

6/4/2024

HB-10.7 GM/DL

TLC-21,000CELLS/CUMM

NEUTROPHILS : 46%

LYMPHOCYTES : 42%

EOSINOPHILS : 2%


MONOCYTES : 10%

BASOPHILS :0

PLATELET COUNT - 80,000/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC WITH FEW MACROPHAGES

HEMOGRAM

7/4/2024

HB-10.5 GM/DL

TLC-14,000CELLS/CUMM

NEUTROPHILS : 51%

LYMPHOCYTES : 37%

EOSINOPHILS : 02%

MONOCYTES : 10%

BASOPHILS :0

PLATELET COUNT - 20,000/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC

PRE-TRANSFUSION HEMOGRAM

8/4/2024

HB-9.1 GM/DL

TLC-12,750CELLS/CUMM

NEUTROPHILS : 48%

LYMPHOCYTES : 42%

EOSINOPHILS : 2%

MONOCYTES : 8%

BASOPHILS :0

PLATELET COUNT - 80,000/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC WITH A FEW MICROCYTES

POST TRANSFUSION HEMOGRAM - 8/4/2024

HB-10.7 GM/DL

TLC-13,500CELLS/CUMM

NEUTROPHILS : 42%

LYMPHOCYTES : 46%

EOSINOPHILS : 2%

MONOCYTES : 10%

BASOPHILS :0


PLATELET COUNT - 62,000/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC WITH FEW MICROCYTES

HEMOGRAM

9/4/2024

HB-10.9 GM/DL

TLC-6400CELLS/CUMM

NEUTROPHILS : 46%

LYMPHOCYTES : 42%

EOSINOPHILS : 5%

MONOCYTES : 7%

BASOPHILS :0

PLATELET COUNT - 2.24LAKHS/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC

USG ABDOMEN DONE OM 4/4/2024

IMPRESSION : ACALCULUS CHOLECYSTITIS , MILD ASCITIS

REVIEW USG 5/4/2024

IMPRESSION: ACALCULOUS CHOLECYSTITIS , RIGHT MODERATE &LEFT MILD PLEURAL EFFUSION

URINE CULTURE REPORT : NO PUS CELLS SEEN , NO GROWTH

THROAT SWAB CULTURE REPORT : NON-ALBICANS CANDIDIASIS ISOLATED

11/4/2024

HB-10.1 GM/DL

TLC-6300CELLS/CUMM

NEUTROPHILS : 45%

LYMPHOCYTES : 42%

EOSINOPHILS : 04%

MONOCYTES : 09%

BASOPHILS :0

PLATELET COUNT - 79,000/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC

12/4/24

HB-10.2 GM/DL

TLC-8300CELLS/CUMM

NEUTROPHILS : 30%


LYMPHOCYTES : 58%

EOSINOPHILS : 01%

MONOCYTES : 11%

BASOPHILS :0

PLATELET COUNT - 1.04 LAKH/CUMM

SMEAR - NORMOCYTIC NORMOCHROMIC

Treatment Given(Enter only Generic Name)

1)IVF NS @100ML/HOUR

2)INJ.MONOCEF 5 DAYS

3)INJ.DOXYCYCLINE 4DAYS

4)INJ.OPTINEURON

5)TAB.RACECADODRIL 100MG PO TID

6)INJ. ZOFER 4MG IV SOS

7)TAB.SPOROLAC DS PO TID

8)ZYTEE GEL L/A TID

9)CANDID MOUTH PAINT FOR L/A TID

10)ORS 1 SACHET IN 1 LITRE WATER , AFTER EACH EPISODE OF LOOSE STOOLS

Advice at Discharge

1) PLENTY OF ORAL FLUIDS

2)TAB.RACECADODRIL 100MG PO TID

3)TAB. ZOFER 4MG PO SOS

4)TAB.SPOROLAC DS PO TID

5)ZYTEE GEL L/A TID

6)CANDID MOUTH PAINT FOR L/A TID

7)ORS 1 SACHET IN 1 LITRE WATER , AFTER EACH EPISODE OF LOOSE STOOLS





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