DENGUE
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A 70 year old female patient came to OPD with Chief complaints of
fever since 20 days
Pain while swallowing since 10 days
Pain in abdomen since 2 days
Shortness of breath since 1day
History of presenting illness:
Patient was apparently asymptomatic 20 days back then she developed fever which was high grade and intermittent type,associated with generalized body weakness,chills, she went to a rmp near by and took some medication which relieved the fever for 2 days and again fever get started she went to another hospital where she was diagnosed with Dengue and treated but she developed pain abdomen from 3 days and SOB since 1day for which she underwent an USG and diagnosed as ascites and was referred to our hospital She was complaining about difficulty in swallowing since 7 days
Past history:
Not a known case of DM,HTN, TB,CAD AND CVA ASTHMA, EPILEPSY
FAMILY HISTORY :NOT significant
Personal History:
Diet-mixed
Appetite-reduced
Bowel and Bladder movements-bowels movements reduced
Addictions no
Allergies no
Drug history : not significant
General examination:
Patient is conscious coherent cooperative and was well oriented to time place and person
at the time of examination She is examined in a well lit room, with consent taken
She is moderately built and moderatly nourished.
Pallor-absent
Icterus- absent
Cyanosis absent
Clubbing - absent
lymphadenopathy-absent
Pedal edema - present bilateral
Vitals:
Temperature afebrile
Pulse rate-82 bpm
Respiratory rate-24 cpm
Blood pressure-110/90 mmHg
Sp02-94% on Room air
GRBS 92mg/dl
Systemic examination:
CVS:S1,S2 heard Only Diastolic murmur in Aortic area
RS:BAE present, NVBS heard + Reduced breath sounds in rt>left
CNS : Intact
Per abdomen:
Shape of the abdomen : distended
No Fluid thrill
No shifting dullness
soft tender,
no organomegaly detected
PROVISIONAL DIAGNOSIS: dengue
INVESTIGATIONS :
Complete blood picture
Hb 12.5
TLC 18,300
Platelet count :1.35
COMPLETE URINE EXAMINATION (CUE) :
COLOUR :Pale yellow
APPEARANCE: Clear
REACTION :Acidic
SP GRAVITY :1.010
ALBUMIN :Nil
SUGARS: Nil
BILE SALTS :Nil
BILE PIGMENTS:Nil
PUS CELLS:2-3
EPITHELIAL CELLS: 1-2
RED BLOOD CELLS:Nil
CRYSTALS : Nil
CASTS:Nil
AMORPHOUSDEPOSITS: Absent
OTHERS :Nil
Anti HCV Antibodies : Non Reactive
WIDAL TEST:
S.typhi 'O' Antibodies: No Agglutination seen
S.typhi 'H' Antibodies :No Agglutination seen S.PARATYPHI AH : No Agglutination seen
ANTIBODY
S.PARATYPHI BH : No Agglutination seen
ANTIBODY
SERUM CREATININE:. 0.9 mg/dl 1.2-0.6 mg/dl
LIVER FUNCTION TEST (LFT) :
Normal ranges
Total Bilurubin :1.65 mg/dl 1-0 mg/dl
Direct Bilurubin :0.40 mg/dl 0.2-0.0 mg/dl
SGOT(AST): 64 IU/L 31-0 IU/L
SGPT(ALT) : 35 IU/L 34-0 IU/L
Alkaline phosphate :225 IU/L 141-53 IU/L
TOTAL PROTEINS: 5.1 gm/dl 8.3-6.4 gm/di
ALBUMIN : 2.25 gm/dl 4.6-3.2 gm/dl
A/G RATIO : 0.79 4.6-3.2 gm/dl
SERUM ELECTROLYTES (Na, K, CI) AND SERUM IONIZEDCALCIUM :
SODIUM : 132 mEq/L 145-136 mEq/L
POTASSIUM: 4.5 mEq/L 5.1-3.5 mEq/L
CHLORIDE : 99 mEq/L 98-107 mEq/L
CALCIUM IONIZED. : 0.89 mmol/L
ABG :
PH : 7.47
PC02 : 23.2
PO2. : 61.6
HCO3 : 16.9
St. HCO3. : 20.6
BEB : - 4.5
BEecf : -6.0
TCO2 : 33.0
02 Sat : 93.8
BLOOD UREA : 55 mg/dl
ECG :
Doppler :
Ultrasound:
TREATMENT:
1)IV FLUIDS 2NS,1RL 75ML/HR
2)INJ.PIPTAZ 4.5GM IV/TID
3)T.DOXY 100MG PO/BD
4)T.PAN 40MG PO/OD
5)T.DOLO 650MG PO/SOS
6)T.ULTRACET 1/2 TAB PO/QID
7)CHLORHEXIDINE GARGLES IN WATER/TID
Advice at Discharge:
1)T.DOXY 100MG PO/BD FOR 2 DAYS
2)T.PAN 40MG PO/OD FOR 8 DAYS
3)T.DOLO 650MG PO/SOS
4)T.ULTRACET 1/2 TAB PO/SOS
5)CHLORHEXIDINE GARGLES IN WATER/TID
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