50 years old female came to the OPD with chief complaints of fever since 4 days (Not associated with the chills and rigors) Present through out the day , subsided as taken medication.

C/o Burning micturition since 2 days

C/o Abdominal distension since 4 days


Hopi :

She was apparently asymptomatic  4 days back then she developed fever 

No c/o Cold, cough , shortness of breath, bilateral pedal edema , headache , giddiness 


Past history : 

Not a known case of diabetes mellitus , hypertension , Epilepsy , TB , CAD , CVA


Personal history

Diet : mixed 

appetite : normal 

bowel and bladder moments : regular

Micturition : normal 


Family History :

Not significant







On examination : 

Patient is conscious , coherent , cooperative

Temperature : afebrile (98.8.f)

BP : 110/90 MMhg 

pulse rate : 100beats per minute

Respiratory rate : 18 cycles per minute

SPO2 : 96%

No signs Pallor , ictreus , cyanosis , clubbing , lymphadenopathy, edema of feet


System examination : 

Cvs : s1,s2 heard , no murmurs

Rs : bae+


Investigations : 


HEMOGRAM: 

HB: 13.8

TLC: 3,700

N/L/E/M/B: 45/46/01/08/00

PCV: 40.9

MCV: 109.5

MCH: 36.9

MCHC:33.7

RBC:3.74

PT:8000

RDW-CV :13.5

RDW-SD: 56.2

PS: NC/NC


Ecg :




Usg : 
                   


2d echo : 
                        








Review usg : 




Dermatology referral:



Provisional diagnosis : 

Dengue NS1 antigen positive


Treatment : 

  1. ivf - ns and rl @ 100ml/hr
  2. Inj. Pantop 40 mg/iv/od
  3. Inj. Zofer 4 mg/iv/sos
  4. Inj. Neomal 100ml ( if temp > 101.1.f) iv/sos
  5. Tab. Mvt /po/od
  6. Fever charting hourly 
  7. Bun,plv daily

Soap notes :
Amc
Day 2
Bed no : 3
50y/F

S: shortness of breath (grade -2 ) 
    Petechiae + on abdomen 
   1 pack of SDP transfusion done yesterday 

O:
O/e
Patient is c/c/c
Temp:Afebrile
Pr:97bpm , regular, low volume
Rr:17cpm
Bp:110/80 mmhg
Spo2:97% at RA
Cvs: S1 S2 +, no murmurs
Rs: Decreased breath sounds in right ISA , IAA
PA: distended , bowel sounds+
GRBS: 114mg/dl

A : dengue NS1 antigen positive with k/c/o , HIV + with right sided pleural effusion 

P:
1.Ivf - 1 Ns , 1 Rl @ 150ml / hour with 1 amp of optineurin
2.inj pan 40mg/iv/od
3.inj zofer 4mg/iv/sos
4.inj neomol  100ml /iv/ if temp > 101.1°F
5.tab.pcm 500mg/po/bd
6.pcv and bun daily 
7.Monitor vitals 4th hrly
8.check for bleeding manifestations

https://abhinavyarragunta.blogspot.com/2022/03/50-years-old-female-came-to-opd-with.html

Amc Bed  3
Day 3
50y/F

S: shortness of breath (grade -2 ) 
    Petechiae + on abdomen 
    Cd4 - 585(21/12/21)

O:
O/e
Patient is c/c/c
Temp:Afebrile
Pr:100bpm , regular, low volume
Rr:17cpm
Bp:110/80 mmhg
Spo2:97% at RA
Cvs: S1 S2 +, no murmurs
Rs: Decreased breath sounds in right ISA , IAA
PA: distended , hepatomegaly+ , liver - 14cm , bowel sounds +
Grbs : 96mg/dl

A : dengue NS1 antigen positive with k/c/o , HIV + with right sided pleural effusion 

P:
1.Ivf - 1 Ns , 1 Rl @ 150ml / hour with 1 amp of optineurin
2.inj pan 40mg/iv/od
3.inj zofer 4mg/iv/sos
4.inj neomol  100ml /iv/ if temp > 101.1°F
5.tab.pcm 500mg/po/bd
6.pcv and bun daily 
7.Monitor vitals 4th hrly
8.check for bleeding manifestations


Amc Bed  3
Day 4
50y/F

S: no fever spikes 

O:
O/e
Patient is c/c/c
Temp:Afebrile
Pr:97bpm , regular, low volume
Rr:17cpm
Bp:110/80 mmhg
Spo2:97% at RA
Cvs: S1 S2 +, no murmurs
Rs: Nvbs + , decreased breath sounds in right isa , msa
PA: soft , distended , bowel sounds+ , hepatomegaly+

A : dengue NS1 antigen positive with k/c/o HIV + since 13 years with right sided pleural effusion with borderline tuberculoid leprosy ? Type 1 reaction 

P:
1.Plenty of oral fluids
2.inj pan 40mg/iv/od
3.inj zofer 4mg/iv/sos
4.inj neomol  100ml /iv/ if temp > 101.1°F
5.tab.pcm 500mg/po/bd
6.pcv and bun daily 
7.Monitor vitals 4th hrly
8.check for bleeding manifestations
9.liquid paraffin L/A bd


Ward
Day 5
50y/F

S: no fever spikes 

O:
O/e
Patient is c/c/c
Temp:Afebrile
Pr:97bpm , regular, low volume
Rr:17cpm
Bp:110/80 mmhg
Spo2:97% at RA
Cvs: S1 S2 +, no murmurs
Rs: Nvbs + , decreased breath sounds in right isa , msa
PA: soft , distended , bowel sounds+ , hepatomegaly+

A : dengue NS1 antigen positive with k/c/o HIV + since 13 years with right sided pleural effusion with borderline tuberculoid leprosy ? Type 1 reaction 

P:
1.Plenty of oral fluids
2.inj pan 40mg/iv/od
3.inj zofer 4mg/iv/sos
4.inj neomol  100ml /iv/ if temp > 101.1°F
5.tab.pcm 500mg/po/bd
6.pcv and bun daily 
7.Monitor vitals 4th hrly
8.check for bleeding manifestations
9.liquid paraffin L/A bd

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