17 year old with fever with thrombocytopenia
17 year old male patient came to the OPD on 11/10/21 with complaints of fever since 3 days.
Patient was apparently asymptomatic 3 days back, then he developed fever which was a/w with chills and rigor which subsided on taking medication.
H/O vomiting 3 episodes 3 days back, non bilious, non projectile, ood particles as content.
Patient was taken to the local RMP and was taking treatment for dengue ( Tested NS1 positive )
No c/o chest pain, palpitations, shortness of breath, pain abdomen, loose stools, headache.
Referred to KIMS i/v/o low platelet count. ( 40,000 )
Patient in not a k/c/o DM, HTM.
Personal History:
Diet- mixed
Appetite - normal
Sleep- adequate
Bowel and bladder movements- regular
No known addictions
Vitals on admission:
Temp- 98.5
PR- 99 bpm
BP- 110/80 mmhg
RR- 18 cpm
SpO2- 99% at RA
GRBS- 142 mg/dl
O/E
Patient c/c/c
CVS- S1 S2 +. No murmurs
RS-trachea - central NVBS+. No Crepts
P/A - soft, non-tender
Provisional Diagnosis:
Fever with thrombocytopenia ( NS1 positive)
Investigations:
USG ABDOMEN- Impression:
Gallbladder wall edema
Mild ascites
ECG
X-Ray chest:
Platelet count on 12/10/21 was 16,000
1 unit SDP transfusion given.
Post transfusion plc- 35,000
Day 3
S:
No fever spikes
O:
Pt c/c/c
Temp-98.2F
BP-120/90 mmhg
PR-86 bpm
RR- 17 cpm
CVS- S1 S2 +. No murmur
RS- NVBS+. No crepts
P/A- soft, non tender
CNS- NAD
Petechiae present over left shoulder.
Platelet count on 12/10/21- 16,000
1 unit SDP Transfusion given on 12/10/21
Post transfusion platelet count on 13/10/21- 35,000
A:
Dengue fever with NS1 positive with thrombocytopenia
P:
IVF - NS, RL, DNS @ 100 ml/hr
INJ PANTOP 40 mg /IV/OD
INJ NEOMOL 1g /IV/ SOS
Tab. DOLO 650 mg PO / SOS
Watch for bleeding manifestations
Monitor vitals
Day 4
S:
No fever spikes
O:
Pt c/c/c
Temp-98.4F
BP-110/70mmhg
PR-74 bpm
RR- 18 cpm
CVS- S1 S2 +. No murmur
RS- NVBS+. No crepts
P/A- soft, non tender
CNS- NAD
Petechiae present over left shoulder.
Platelet count on 12/10/21- 16,000
1 unit SDP Transfusion given on 12/10/21
Post transfusion platelet count on 13/10/21- 35,000
Platelet count on 14/10/21- 40,000
Manual count - 72,000
A:
Dengue fever with NS1 positive with thrombocytopenia
P:
IVF - NS, RL, DNS @ 100 ml/hr
INJ PANTOP 40 mg /IV/OD
Tab. DOLO 650 mg PO / SOS
Watch for bleeding manifestations
Monitor vitals
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