General medicine case 11

 General Medicine Case 11

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A 20 year old male,who works in a sweet shop is a resident of khatanqur came to casualty with chief complaints of fever since 5 days. 

History of Present illness:-

Patient was asymptomatic since 5 days ago then he developed high grade fever not associated with chills and rigors which was intermittent and with no diurnal variations. No h/o vomitings,loose stool.No h/o cough,SOB.No h/o burning micturition.No h/o hematuria,melena, bleeding gums, hematemesis and no other bleeding manifestations .

Past History:-

Not a know case of Hypertension, Diabetes, Asthma, tuberculosis, CVD, Epilepsy.

Personal History:-

Sleep is adequate.

Appetite is normal.

Patient takes mixed diet.

Bowel and bladder movements are regular.

No addictions.

Family history:-

No members in family has similar complaints.

Drug history:-

No drug allergy to known drugs.

General examination:-

Patient was conscious, coherent, cooperative,well oriented to place and time.

No anemia, no pallor, no cyanosis, no icterus, no clubbing, no generalised lymphadenopathy.


Vitals:-

Temperature---- 99°F

Respiratory rate--- 18 cpm

Pulse rate--- 98 bpm

Blood pressure---110/90 mm Hg

Systemic Examination:-

RS: Bilateral air entry+;clear 


P/A:soft,non tender 


CVS:S1S2+


CNS:NFD

Investigations:-

Albumin-trace 


Sugar-nil 


Pus cells-3-4 


Epithelial cells-2-3 


RBS-109 Mg/dl 


Urea-26 mg/dl 


LFT: 


T.bil-0.69 


D.bil-0.18 


AST-50 


ALT-19 


ALP-128 


T.Protein-6.0 


Albumin-2.6 


A/G-0.76 


Sr.creatinine-1.4 


Na-138 


K-3.8 


Cl-98 


HCV-negative 


Provisional diagnosis:-

 Dengue NS1 positive with thrombocytopenia 

Treatment:-
1)IVF:NS,RL,DNS @100 ml/hr
2) PLENTY OF ORAL FLUIDS
3)INJ.PAN 40MG IV/OD
4)TAB.DOXY 100 MG PO/BD
5)TAB.DOLO 650 MG PO/SOS
6)LOOK FOR BLEEDING MANIFESTATIONS
7)INJ OPTINEURON 1AMP IN 100 ML NS IV/OD
8)GRBS 12TH HORLY
9)LOOK FOR POSTURAL DROP IN BP 
10)INJ.NEOMOL IF TEMP >101 DEGREES F IV/SOS



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