23 yr old male with fever and abdominal pain
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A 23year old male resident of nakerekal came with the cheif complaints of fever since one week and abdominal pain since one week
patient was apparently asymptomatic one week back and then he developed fever which was low grade increasing in the night associated with abdominal pain more in the umbilical region and right hypochondrial region aggravated on walking and doing work and decreased on rest, 2 episodes of vomitings on 1st day , subconjuctival hemorrhage and erythematous rash on the inner thighs on the 2nd day and there is history of constipation for 2days so admitted in the local hospital and diagnosed as dengue positive, rash subscied after 3 days, no cough and cold
PAST HISTORY:
No history of diabetes, hypertension, epilepsy
Tb,
H/o of poilo to the right leg after one year of birth
Family history: not significant
PERSONAL HISTORY:
Diet-mixed
Appetite-normal
Sleep-adequate
Bowel and bladder movements-regular Addictons-none
GENERAL EXAMINATION:
Patient is conscious, coherent and cooperative. moderately built and nourished.
Pallor-absent
Icterus-absent
Clubbing-absent
Cyanosis-absent
Generalised lymphadenopathy-absent
Pedal edema-absent
Pulse rate-98bpm
Respiratory rate- 18cpm
Blood pressure -140/90
Spo2- 98%at room air
Cardiovascular system:
S1 and S2 heard no murmurs heard
Central nervous system:
No focal neurological deficit, cranial nerve
intactCentral nervous system:
Patient is concious coherent.
Higher mental status-
Cranial nerves- intact
Motor
Tone- normal
Power- normal
Cerebellar functions-normal
Respiratory system:Bilateral air entry-present ,Normal vesicular breath sounds-heard
Abdominal examination: soft and non tender, No Hepatomegaly, spleen is not palpable
INVESTIGATIONS
INVESTIGATIONS
Hemogram
Hemoglobin 12.3g/dl
RBC count 4.27 million/mm3
Platelets 0.20 lakhs/mm3
Wbc count : 12,040 mcl
Eosinophils 02%
Basophils 00
Neutrophils 59%
Monocytes 08%
Lymphocytes 28%
Ultrasound abdomen :
Mild bilateral pleural effusion
Wall of gallbladder is thick and edematous
Mild ascites
PROVINCIAL DIAGNOSIS:
dengue hemorhagic fever associated with hepatitis
Treatment:
Platelet transfusion was done
IVF NS and RL 100/hr
Inj doxycycline 100mg/N/BD
INJ.PAN 40MG/PO/OD
DOLO650 /PO/TID
INJ NEOMOL 1gm/N/SOS
T.CITRIZINE 10mg
T.GRILLINCTUS 10ml/PO/TID
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