A 18year old male patient came with the chief complaints of fever since 4 days

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A 18 year old boy,resident of vangamarthi,who had completed his intermediate came to casuality with the chief complaints of fever,body pains and weakness since 4days.

HOPI:

Patient was apparently asymptomatic 4days back and then he developed fever,body pains and weakness.Fever was intermittent,high grade fever during morning and gradually decreased by evening after taking medications,not associated with chills.H/o headache in association with fever and subsided gradually as the fever decreased.Body pains developed along with fever mostly lower limbs are painfull which was dragging type of pain and there is weakness.There is h/o abdominal pain since yesterday morning which was dragging type and localised to epigastric region.There was cracking of upper lip.

No chills,No petechia seen,no h/o diarrhea,no h/o nausea,photophobia.

Patient had h/o fever,bloody diarrhea 1month back.Then the fever was on and off,high graded and he passed loose stools 4-5 times/day for 2days.Then he gave blood sample suspecting typhoid which was positive and then he went to nalgonda and got treated.

Past history:

No similar complaints in the past.

Personal history:

Diet:Mixed

Appetite:Decreased

Sleep: Adequate

Bowel movements decreased since 3days and regular bladder movements.Today he passed stools.

No addictions.

General physical examination:

Patient is conscious, coherent, co-operative and we'll oriented to time,place,person.He is moderately built and nourished. 

No signs of pallor,icterus,cyanosis,clubbing,generalised lymphedenopathy and edema.

Vitals:

On 7th oct,2022

PR:92 BPM

RR:18 cpm

BP:90/70mm hg

Spo2:98% at room air

GRBS:96mg%

On 8th oct,2022

Temperature:97.9F

PR:90 BPM

RR:18 cpm

BP:100/70mmhg.

Systemic examination:

CVS:S1,S2 heard no murmurs

RS: Bilateral air entry present,Normal vesicular breathe sounds heard

CNS:No neurological focal deficits.

Per abdomen:

On inspection:

Shape of the chest:flat

Flanks:

Position of umbilicus:center

Skin over the abdomen is normal

No scars,sinus,engorged veins

Movement of abdominal wall

No visible peristalsis.

No hernial orifices.

On palpation:

There is no local rise of temperature and slight tenderness on epigastric region.

All the inspectory findings are confirmed by palpation

Liver:

Non tender,soft in consistency

Spleen:

Non tender,soft in consistency

Percussion:

Liver span:

No spleenomegaly

Auscultation:

Bowel sounds heard.

No venous hum heard.

Investigations:

Hemogram:

Showing-Decreased platelet count and WBC count.

Complete urine examination (CUE)-Normal.

USG:

Gallbladder wall edema 

Minimal ascites

Provisional diagnosis:

Viral pyrexia with thrombocytopenia

Dengue NS1 Positive.

Treatment:

-i.v fluids:20 normal saline and 10 ringerlactate  both 100ml/hr 

-Inj.NEOMOL 1mg,i.v if temp.>101F

-inj.PAN 40mg,i.v  OD

-inj.OPTINEURON 1amp in 100ml NS,i.v,OD

-inj.ZOFER 4mg,i.v if required 

-Tab.DOLO 650mg,per oral,TID

-Temperature charting every 4thhrly 

-Moniter vitals.