DENGUE HEMORRHAGIC FEVER

Case History and Clinical Findings CHIEF COMPLAINTS : C/O DRY COUGH SINCE 7 DAYS C/O SOB SINCE 4 DAYS C/O ABDOMINAL DISTENSION SINCE 4 DAYS C/O DECRAESED URINE OUT PUT SINCE 4 DAYS HOPI
PATIENT WAS APPARENTLY ALRIGHT 7 DAYS BACK THEN SHE DEVELOPED FEVER ASSOCIATED WITH CHILLS AINSIDIOUS IN ONSET NOT ASSOCIATED WITH MYALGIA OR ARTHRALGIA H/O DRY COUGH SINCE 7 DAYS , NO SEASONAL VARIATION OR DIURNAL VARIATION, NOT ASSOCIATED WITH BLOOD,FEVER ASSOCIATED WITH DECREASE IN APPETITE ON DAY 1 OF ILLNESS SHE SOUGHT CONSULTATION FOR RMP AND WAS TAKING TREATMENT ON DAY3 OF ILLNESS SHE WAS HAVING SOB GRADUALLY PROGRESSIVE FROM GRADE 1 TO 5 ON NYHA H/O ABDOMINAL DISTENSION SINCE 4 DAYS GRADUALLY PROGRESIVE TO PRESENT SIZE ASSOCIATED WITH ABDOMINAL PAIN H/O DECRESED URINARY OUT PUT SINCE 4 DAYS NO HEMATURIA, BLOOD IN STOOLS, OR OTHER BLEEDING MANIFESTATIONS COMPLAINTS PAST HISTORY : K/C/O DM SINCE 1 YEAR NOT A K/C/O DM, TB, ASTHMA, TB, EPILEPSY, HYPERTENSION PERSONAL HISTORY : APPETITE : NORMAL DIET : MIXED BOWEL AND BLADDER : REGULAR SLEEP : ADEQUATE ADDICTIONS : OCCASIONAL ALCOHOLIC AND TODDY DRINKER MENSTRUAL HISTORY : 
AGE OF MENARCHE : 13 YEARS
 CYCLES : REGULAR ATTAINED MENOPAUSE OBSTRETRIC HISTORY : NULLIPAROUS GENERAL EXAMINATION : 
PATIENT WAS CONSCIOUS , COHERENT COOPERATIVE PETECHIAE PRESENT 
VITALS : TEMP : AFEBRILE BP :130/80 MMHG HR : 78BPM SPO2 : 98% ON RAGRBS : 142 MG/DL
 SYSTEMIC EXAMINATION: 
CNS : GCS : E4V5M6 PATIENT WAS CONSCIOUS , ORIENTED TONE AND POWER NORMAL IN ALL LIMBS REFLEXES : B T S K A P RT ++ ++ + + ++ F LT ++ ++ + ++ ++F CRANIAL NERVES INTACT
 CVS : S1, S2 HEARED NO MURMURS
 RS : BAE + , CLEAR
 P/A : SOFT NONTENDER , BS :+
 BRIEF COURSE IN HOSPITAL :
57 YEAR OLD WOMEN WHO PRESENTEDTO THE CASUALTY WITH DENGUE FEVER WITH THROMBOCYTOPENIA IN A TACHYPNOEIC STATE AND WITH PETECHIAE. SHE HAD INTACT SENSORIUM ON DAY 1, ON FURTHER EVALUATION SHE WAS FOUND TO HAVE PRE RENAL ACUTE KIDNEY INJURY ALONG WITH LIVER INJURY. 
ON DAY 2, 
SHE WENT INTO ALTEREDSENSORIUM WITH HYPONATREMIA OF AROUND 122 MG/DLOF SERUM SODIUM,3% NACL WAS GIVEN, EVEN POST SODIUM CORRECTION HER SENSORIUM HASNT IMPROVED . CT BRAIN WAS DONE TO RULE OUT BLEED WHICH WAS ABSENT . EVEN FUNDOSCOPY WAS DONE TO RULE OUT RAISED ICT .
 DAY 3:
 HER ALTEREDSENSORIUM WAS SECONDARY TO ? DENGUE ENCEPHALITIS ? HEPATIC ENCEPHALOPATHY ? UREMIC ENCEPHALOPATHY INJ DEXA 8 MG WAS GIVEN I/V/O CONTINUOUS FEVERSPIKES INJ ARTESUNATE WAS STARTED ON DAY 3 . HER UREMIA AS WELL AS HEPATIC ENZYMES ARE CONSTANTLY RISING WE TOOK HER TO 2 SESSIONS OF HEMODIALYSIS ON 29, 30 TH DECEMBER 3RD HEMODIALYSIS SESSION DONE ON 2ND JANUARY N ACETYLCYSTEINE WAS STARTED FOR 3DAY SON I/V/O ACUTE LIVER INJURY AND PERSISTANTLY HIGH BILIRUIN LEVELS PATIENT SENSORIUM IMPROVED ON 1ST JANUARY. GASTRO OPINION WAS TAKEN. HE ADVISED TEST FOR ANTIBODIES HEPATITIS A AND E AND ASKED REVIEW WITH LFT REPORTS.ON 9 TH JAN HER HEMOGRAM WAS SHOWING HB :10, TLC :8,900, PC : 1.65 LAKH ,PT :20SEC,INR : 1.48 ,APTT : 39 SEC PATIENT WAS DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION. Investigation USG ABDOMEN : NO SONOLOGICAL ABNORMALITY DETECTED 2D ECHO EF : 60% NO RWMA TRIVIAL TR/MR SCLEROTIC AV, NO AS/MS 2D ECHO :IVC SIZE : 1.10 CMS GOOD LV SYSTOLIC FUNCTION NO DIASTOLIC DYSFUNCTION,NO PAH/PE REVIEW ECHO 0N 2/123 IVC COLLAPSING: 1.38 CMS MALARIAL PARASITE NEGATIVE,RT-PCR NEGATIVE BLOOD AND URINE CULTURE SENSITIVITY : NO GROWTH DETECTED AFTER 48 HOURS OF INCUBATION 
Diagnosis
 1 DENGUE HEMORRHAGIC FEVER OR EXPANDED DENGUE FEVER WITH POLYSEROSITIS ( RESOLVED )
 2 ALTERED SENSORIUM (RESOLVED ) SECONDARY TO ? DENGUE ENCEPHALITIS /HEPATIC/UREMIC ENCEPHALOPATHY 
3 PRE RENAL AKI(RESOLEVD) 
4 ACUTE LIVER INJURY
5GRADE II BEDSORES 
6 KNOWN CASE OF TYPE 2 DM
Treatment Given
 IV FLUIDS @ 100ML/HR 
INJ PIPTAZ 2.25 GM /IV/TID
INJ VIT K 1 AMPOULE IN 100ML NS IV /OD TAB DOXYCYCLINE 100MG /PO/BD 
INJ OPTINEURON 1 AMPOULE IN 100 ML NS IV /OD
 SYP POTCHLOR 10 ML/TID
 INJ HUMAN ACTRAPID INSULIN /SC/ TID 4U-4U-4U DRINK PLENTY OF ORAL FLUIDS DAILY BEDSORE DRESSING 3 HEMODIALYSIS SESSIONS DONE
 Advice at Discharge
 1.INJ. HUMAN ACTRAPID INSULIN SUBCUTANEOUS THRICE A DAY 8AM--2PM--8PM 4U--4U--4U 
2.TAB.RIFAGUT 550MG ORALLY TWICE A DAY 7AM-9PM FOR 7DAYS
3.TAB.PAN 40MG ORALLY ONCE A DAY AT 7AM BEFORE BREAKFAST FOR 5DAYS 
4.SYP HEPAMERZ 15ML ORALLY THRICE A DAY 8AM-2PM-8PM FOR 15DAYS 
5.SYP POTKLOR 10ML ORALLY THRICE A DAY 8AM-2PM-8PM 
6.SYP LACTULOSE 10ML ORALLY TWICE A DAY 8AM-9PM FOR 7 DAYS 
7.CREAM ZINC OXIDE FOR LOCAL APPLICATION 
8. WATCH FOR HYPOGLYCEMIC SYMPTOMS [EXPLAINED TO PATIENT] 
Follow Up 
REVIEW IN MEDICINE OPD ON 17/1/23 WITH HEMOGRAM, LFT AND RFT REPORTS.

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