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










Petechiae present on left shoulder.

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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