60 year old male with fever since 6 days.
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A 51 year old male resident of narketpally came with Cheif complaints of fever since 7 days associated with headache.
History of presenting illness
The patient was asymptomatic 7 days back when he developed fever which was insidious in onset intermittent , low grade and subsided temporarly on taking medication . it was associated with headache (in the frontal
region), neck pains , back pain , body pains .
Past history
No history of diabetes, hypertension ,asthma, TB ,epilepsy .
6 years back there was an accident ( trauma ).
Personal history
Diet : mixed
Appetite : decreased
Sleep : adequate
Bowel and bladder : regular
Addictions : a chronic alcoholic takes daily occasionally doesn't drink (at least 90 ml /day ) since 30 yrs.
He is a chronic smoker since 30 yrs.
The person is a farmer and he came from an endemic area of dengue.
General physical examination
Patient was conscious coherent Cooperative moderately built and nourished well oriented to time place and person
Pallor absent
Ictherus absent
Cyanosis absent
Clubbing present
Lymphadenopathy absent
Edema absent
Temperature afebrile
Bp 110/70
RR 15
PR 69
Systemic examination
CVS : On inspection : there is pectum excavatum auscultation .
S1 S2 heard no murmurs
RS BAE + Per abdomen
Shape distended
No scars and sinus umbilicus center soft and Non tenderness
CNS no focal neurological deficits
Investigations:
CBP: -
Platelets on day of admission 11,000 increased to 12,000the next day
CUE :-
Colour pale yellow
Albumin +++
Pus cells 4 - 5
Epithelial cells 2- 4
RBS : 114
MP - ve
Mp strip -be
RFT: -
Urea : 35 mg/DL
Creatinine : 1.2
Uric acid : 6.1
Ca+2 : 9.9
Phosphorus : 3.5
Na+ : 138
K+ : 3.7
Cl- : 98
LFT
TB : 0.73
DB : #0.26
SGOT :#102
SGPT:#50
ALP:#234
TP:6.4
ALB : 3.7
A/G ratio : 1.35
Provisional diagnosis
Viral pyrexia with thrombocytopenia
With NS1 +
Treatment
1) IVF ns , RL at 125ml/min
2) INI ZOFER 4mg IV sos
3) temp monitoring every hourly
4) Bp monitoring every 4th hourly
5) w/f bleeding manifestation
6) strict i/o charting
7) GRBS monitoring 6th hrly.