25 yrs old female with dengue fever

 

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25 yr old female housewife by occupation resident of nalgonda came to general medicine OPD with 

Chief complaints:-

Body pains since 6 days

Fever since 3 days

History of presenting illness:-

Patient was apparently asymptomatic 6 days back then she started developing body pains insidious in onset ,gradually progressive, dragging type symmetrica in nature small joints are involved more not associated with swelling local rise of temperature and redness,aggravated during fever no relieving factors 

Fever since 3 days sudden in onset continues in nature high grade associated with chills and rigors relieving on medication no aggravating factors

Headache since 3 days during fever dragging type relived on medication and rest

History of Vomitings 4 days back projectile type non bilious 3-4 episodes 

History of watery loose stools 4 days back 3-4 episodes 

History of petechial rash on left fore arm one day of admission after applying Bp cuff 

No history of cough,night sweats, abdominal pain,pedal oedema,retro orbital pain.

Past history:- 

She is not a known case of diabetes, hypertension,asthma,CAD,epilepsy,TB,and thyroid disorders.

Family history:-

Not significant 

Personal history:-

Diet-mixed, loss of Appetite ,Sleep-adequate Bowel and bladder movements -normal Addictions-no,no allergies.

DAILY ROUTINE: 

*Before illness

Patient wakes up at 8:00 Am

Do breakfast at 9:00 Am

Does daily household work 

Then have lunch at 1:00 Pm

Snacks with milk at 5:00 Pm

Have dinner at 9:00 Pm 

And then sleep before 11:00 Pm.

*After illness

Now she is waking up at 9:00 Am

Not doing daily work

she is unable to eat because of loss of appetite and her mother is feeding her.

Lunch- 1/4 cup rice with dal

Sleeps till 6:00 Pm evening

Wakes up at 6:00 Pm 

No snacks

Eats dinner at 9:00 Pm

Sleeps at 11:00 pm

Menstrual history:-

Age of menarche -13 years Cycles- regular 3/28,Pads 3 pads/day,Clots and pain abdomen 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 Cpm

PR - 82 bpm

Spo2 -98%

GRBS -203

SYSTEMIC EXAMINATION 

CVS: S1, S2 heard,No thrills and cardiac murmurs

Respiratory:- No dyspnoea, wheezing, trachea - central, Breath sounds - Vesicular

Per Abdomen Examination:

INSPECTION:

Shape of abdomen- scaphoid

Umbilicus-central and inverted

Transverse scar is present

No sinuses and engorged veins

Hernial orifices are free

All Quadrants are moving equally with respiration.

PALPATION:

All inspectory findings were confirmed by palpation

No local rise of temperature and tenderness

Liver-

Spleen- not palpable

Kidney- on Bimanual examination not palpable

PERCUSSION:

Shifting dullness:Absent

Fluid thrill: Absent

Liver span:

Percussion of Traube's space: resonant note heard.

AUSCULTATION: 

Normal bowel sounds heard

No Bruits were heard.

CNS: 

higher mental functions intact,Speech - normal ,No signs of meningeal irritation

Provisional diagnosis:

DENGUE HEMORRHAGIC FEVER with NS1 positive

Investigations 

Treatment:-

28/11/23

IV fluids NS @75 ml/hr

Tab. Doxycycline 100mg PO/BD

Inj. Optineuron 1 amp in 100 ml NS IV OD

Temperature 4th hourly

BP monitoring 2nd hourly

Inj. Zofer 4mg IV BD

Inj. Pan 40 mg OD

1 ORS sachet in 1 l water

200 ml ORS after each episode of loose stools

29/11/23

IV fluids NS @200 ml/hr

Tab. Doxycycline 100mg PO/BD

Inj. Optineuron 1 amp in 100 ml NS IV OD

Temperature 4th hourly

BP monitoring 2nd hourly

Inj. Zofer 4mg IV BD

Inj. Pan 40 mg OD

1 ORS sachet in 1 l water

Inj. PCM 1 gm IV if temp > 101F

30/11/23

IV fluids NS @200 ml/hr

Tab. Doxycycline 100mg PO/BD

Inj. Optineuron 1 amp in 100 ml NS IV OD

Temperature 4th hourly

Inj. PCM 1 gm IV if temp > 101F