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A case of 50 year old patient - fever with thrombocytopenia with NS1 antigen positive

"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment"

A 50 year old female housewife by occupation came with C/O fever since 7 days
C/O headache since 7 days
C/O body pains since 7 days


HOPI-
Patient was apparently asymptomatic 7 days back then developed  fever  associated with chills and rigors ,subsided on taking medications
C/O headache -diffuse type,not associated with nausea ,vomiting since 7 days
C/O body pains since 7 days
Patient was taken to near by RMP and diagnosed with Dengue NS 1 antigen positive and treated conservatively.
HISTORY OF PAST ILLNESS:
No similar complaints in the past 
Not a K/C/O  DM/ TB/ BA / EPILEPSY.
K/c/o Htn since 10 years on amlodipine and atenolol

General examination -
Patient is consious, coherent, co-operative. 
No pallor , icterus, cyanosis, clubbing,koilonychia lymphadenopathy.
VITALS :
Temperature - 98.6F
Pulse rate - 80 BPM, REGULAR, NORMAL VOLUME
BP - 120/80MM OF HG
SPo2 - 98% AT RA
GRBS - 99 mg/dl

SYSTEMIC EXAMINATION - 
P/A : Non distended, soft, non tender. No guarding or rigidity.
CVS : S1 S2 heard 
RS-BAE+
CNS- NAD
Invesigations-
On 13/4/22
Hb-11.7gm/dl
Tlc-1800cells/cumm
N/L/E/M-47/48/0/5
Plt-85,000lakhs/cu.mm
BGT-A +
RBS-202mg/dl
Blood Urea-20mg/dl
UA-4mg%
14/04/22
Hb-12.5
Tlc -1500cells/cumm
N/L/E/M47/48/0/5
PCV -35.9
Plt-60,000


Treatment-
1.IVF -NS,RL
2.INJ.PANTOP 40 MG/IV/OD
3.INJ ZOFER 4MG/IV/BD
4.INJ OPTINEURON 1 AMP IN 100ML NS
5.INJ.NEOMOL 100 ML( IF TEMP >101.1F)
6.TAB.PCM 500MG/PO/SOS
7.MONITOR VITALS HRLY
8.FEVER CHARTING 4TH HRLY
9.CHECK FOR BLEEDING
10.PCV AND BUN -DAILY
ENT referral-

3rd Unit ICU admission 14/4/2022 

* SOAP NOTES Day 1 

S- No fresh complaints 

O- Patient is consious, coherent, co-operative. 

No pallor , icterus, cyanosis, clubbing,koilonychia lymphadenopathy.
VITALS :
Temperature - 98.6F
Pulse rate - 80 BPM, REGULAR, NORMAL VOLUME
BP - 120/80MM OF HG
SPo2 - 98% AT RA
GRBS - 99 mg/dl
SYSTEMIC EXAMINATION - 
P/A : Non distended, soft, non tender. No guarding or rigidity.
CVS : S1 S2 heard 
RS-BAE+
CNS- NAD
A-Fever with thrombocytopenia with NS1 positive 
P-1.IVF -NS,RL
2.INJ.PANTOP 40 MG/IV/OD
3.INJ ZOFER 4MG/IV/BD
4.INJ OPTINEURON 1 AMP IN 100ML NS
5.INJ.NEOMOL 100 ML( IF TEMP >101.1F)
6.TAB.PCM 500MG/PO/SOS
7.MONITOR VITALS HRLY
8.FEVER CHARTING 4TH HRLY
9.CHECK FOR BLEEDING
10.PCV AND BUN -DAILY

3rd Unit ICU admission 15/4/2022 

* SOAP NOTES Day 2

S- No fresh complaints 
O- Patient is consious, coherent, co-operative. 
No pallor , icterus, cyanosis, clubbing,koilonychia lymphadenopathy.
VITALS :
Temperature - 98.6F
Pulse rate -64 BPM, REGULAR, NORMAL VOLUME
BP - 120/80MM OF HG supine 100/80mmhg standing 
SPo2 - 98% AT RA
GRBS - 99 mg/dl
SYSTEMIC EXAMINATION - 
P/A : Non distended, soft, non tender. No guarding or rigidity.
CVS : S1 S2 heard 
RS-BAE+
CNS- NAD
A-Fever with thrombocytopenia with NS1 antigen positive 
P-1.IVF -NS,RL
2.INJ.PANTOP 40 MG/IV/OD
3.INJ ZOFER 4MG/IV/BD
4.INJ OPTINEURON 1 AMP IN 100ML NS
5.INJ.NEOMOL 100 ML( IF TEMP >101.1F)
6.TAB.PCM 500MG/PO/SOS
7 .TAB VERTIN 16MG PO/TID
8.MONITOR VITALS HRLY
9.FEVER CHARTING 4TH HRLY
10.CHECK FOR BLEEDING
11.PCV AND BUN -DAILY
12 VALSALVA MANOEUVRE TID

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