General medicine case-2



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A 27 year old female presented to the OPD with chief complaints of fever, severe and persistent weakness of the body since 5 days. 

History of present illness

Patient was apparently asymptomatic 5 days back before standing illness. Then, the patient was presented to the casualty with the complaints of fever and severe weakness of the body since 5 days. 

Initially the patient had fever 5 days back and had taken the normal medication for the same. Then the patient was normal for 2 days. 

Then the fever has recurred which is persistent for 3 days in association with severe and persistent body pains and vomitings. 

The patient even complains of redness and burning sensation at times in the upper and lower extremities of the body.


Past history 

No history of DM/HTN/Epilepsy/TB/Thyroid disorders

The patient had not undergone any surgeries.

 

Personal history 

Diet : mixed

Appetite : decreased

Bowel and bladder : normal 

Sleep :adequate 

Addictions:none 


Family history

No history of DM/HTN/CVA/CAD/Asthma/thyroid disorders

No similar complaints in the family previously. 

Treatment history 

Not significant. 


General examination

Patient is conscious, coherent and cooperative. 

No pallor, no icterus,no cyanosis,no clubbing,no lymphadenopathy. 

Vitals

Afebrile

Bp :110/70 mm hg

PR: 85bpm

Rr: 14 cpm

Spo2: 98% 


Systemic examination:

CARDIOVASCULAR SYSTEM:

Inspection:

Chest wall is bilaterally symmetrical.

No precordial bulge

No visible pulsations, engorged veins, scars, sinuses

Palpation:

JVP: normal

Auscutation:

Normal with regular heartbeat

S1, S2 heard

No murmurs 


RESPIRATORY SYSTEM-

Position of trachea: central

Normal Bilateral air entry 

No AV sounds


PER ABDOMEN:

Normal. No mass is palpable. 

No organomegaly


CENTRAL NERVOUS SYSTEM:

Patient is Conscious 

Speech: normal

Reflexes: present

Investigations

On 21/08/21

Hemogram:

RBC:4.37 mil/cumm

WBC:3800 cells/cumm

PLATELETS:35000 lakhs/cumm

Hb: 12.4

Blood sugar random: 96mg/dl

Blood group:AB+

Serum electrolytes:

Na+:1.36 meq/dl

K+:3.8meq/dl

Cl-:94 meq/dl

Blood urea:15mg/dl

Serum creatinine:0.9mg/dl

LFT:

SGOT:1.30 IU/L

SGPT:61 IU/L

ALP:80 IU/L

ALBUMIN:3.5gm/dl

On 22 /08/21

Hemogram:

RBC:3.86 millions/cumm

WBC:3200 cells/cumm

PLATELETS:70,000 lakhs/cumm

Hb:10.9

On 23/09/21

PLATELETS:1.3 lakhs/cumm

On 24/08/21

PLATELETS:1.51 lakhs/cumm







PROVISIONAL DIAGNOSIS :

VIRAL PYREXIA WITH THROMBOCYTOPENIA (dengue NS1 positive )


Treatment:

On 21/8/21
1.IVF -NS,RL ,DNS@100ml/hr 
 2. TAB DOLO 650 mg /po/TID 
 3.Temp monitoring 2nd hrly
 4.Plenty of oral fluids

On 22/8/21
SOAP NOTES 

SUBJECTIVE : 
 No fever spikes
 
OBJECTIVE :
 Temp:97.6 F

 ASSESSMENT- VIRAL PYREXIA WITH THROMBOCYTOPENIA (DENGUE NS1 positive) with platelet count 70,000 today

Plan of treatment :
1. IVF -NS,RL ,DNS@100ml/hr 
 2. TAB DOLO 650 mg /po/TID 
 3.Bp /temp/ RR/ spo2 monitoring 4th hrly 
 4.Plenty of oral fluids

 On 23/8/21

SOAP NOTES 
 
SUBJECTIVE : 
 No fever spikes
 
OBJECTIVE :
 Temp:98.8 F
  
ASSESSMENT- VIRAL PYREXIA WITH THROMBOCYTOPENIA (DENGUE NS1 positive) with platelet count 74,000 today

Plan of treatment :
1. IVF -NS,RL ,DNS@100ml/hr 
 2. TAB DOLO 650 mg /po/TID 
 3. Bp /temp/ RR/ spo2 monitoring 4th hrly 
 4.Temp monitoring 2nd hrly
  5.Plenty of oral fluids

On 24/8/21

SOAP NOTES 
 A 24 yr old female with viral pyrexia with thrombocytopenia 
 
SUBJECTIVE : 
 No fever spikes
 
OBJECTIVE :
 Temp:97.6 F
   
ASSESSMENT- VIRAL PYREXIA WITH THROMBOCYTOPENIA (DENGUE NS1 positive) with platelet count 1.57 lakh today

Plan of treatment :
1. IVF -NS,RL ,DNS@100ml/hr 
 2. TAB DOLO 650 mg /po/TID 
 3.Bp /temp/ RR/ spo2 monitoring 4th hrly 
 4.Temp monitoring 2nd hrly
  5.Plenty of oral fluids.

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