20yr/M presented with fever, small multiple red spots in legs.

A 20yr male presented to our opd with oocomplaints of

- high grade fever since 1ooweek associated with vomiting 3episodes /day,bilious vomiting since 2days  on empty stomach,food contents as particles when he eats .

-body pains since 3days aggrevated on sleeping relieved on walking

-h/o malena since 2days

-he was apparently asymptomatic 2months back,later he developed palpitations, shortness of breath, dizziness and headache for which he went to cardiologist at nalgonda and was told that he had irregular heart rate for which he was prescribed few medications and symptoms relieved.Now he developed fever since 7days which is high grade, intermittent type associated with vomiting of 2-3ep/dayand loose stools with foul smelling and mucus but no blood in stool.

PAST HISTORY: 

K/c/o BPPV 

-He is not a k/c/o DM,HTN, seizures,asthma

PERSONAL HISTORY: 

he is a degree final yr student,his diet was mixed, decreased appetite, constipation since 3yrs

normal micturition,non alcoholic and non smoker

FAMILY HISTORY: 

-no similar complaints in the family


GPE: 

Vitals- 

bp-110/90mmhg, 

pr-82bpm,( irregularly irregular) rr-21cpm,

temp-99°F and 

spo2at room air 99%

No Pallor, icterus ,cyanosis ,clubbing koilonychia, generalized lymphadenopathy,Pedal edema


petechiae on B/L legs present


Subconjunctival hemorrhagic spots seen

after ecg hemorrhagic spots were seen where chest leads were placed.


Tourniquet test : positive

Before 

After test


signs of mild dehydration like dry tongue is noticed


SYSTEMIC EXAMINATION: 

P/A-soft non tender 

CVS- no thrills and murmurs.S1 S2 heard

RS- vesicular breath sounds heard,

CNS- nfnd

Investigations:

 heamogram 

On day of admission


2nd of admission ( post sbp given )

3rd day of admission


Cue:

Rapid Dengue test: 


Cxr :

Ecg : 


Usg abdomen: 
Stool for occult blood:

Diagnosis: Dengue hemorrhagic fever with thrombocytopenia.

Treatment: 

  1. Oral fluids upto 3Lit /day

  2. Ivf ns rl dns @100ml/hr

  3.  Inj pantop 40mg iv od

  4. Inj zofer 4mg iv tid

  5. One Ors sachet in 500ml water

  6. Tab sporlac bd

  7. SDP one unit given on 08/09/2020 night

  8. Tab pcm 650mg sos

  9. Bp /pr/ temp charting hrly

  10. I/O charting 

  11. Grbs 8th hrly

  12. Heamogram 12th hrly


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