Chief complaint:
Fever intermittent
Family history:
Patient both maternal and paternal side has diabetic, with no history
of hypertension, cancer or heart disease.
Review of system:
Skin: Warm, moist, no pallor, no jaundice, good skin turgor,no
rashes
HEENT: Anicteric, pink palpebral sclera, no aural discharge, nasal
septum midline, no nasal discharge
Chest: No hemoptysis, no cough,symmetrical chest expansion
Heart: No chest pain,clear breath sounds,no murmur
Abdomen: soft ,non tender ,globular, no scars,
Extremities: No edema, no muscle pain, no joint pain,macular lesion
all over the back.
Physical examination
General Survey: Conscious, coherent and not in cardiorespiratory
distress
Vital signs: T-36, HR 76, R-2, BP- 100/70
Skin: Warm to touch, moist with good skin turgor, (+) upper
extremities rashes
HEENT: Anicteric, pink palpebral sclera, no aural discharge, nasal
septum midline, no nasal discharge,
Chest: Symmetrical chest expansion, no retractions, (-) crackles
Heart: Adynamic Precordium; normal rate , regular rhythm; no
murmurs
Abdomen: flat, normoactive bowel sounds, soft, tender abdomen
DRE: not assessed
Extremities: (-) edema, (-) cyanosis, (+) rashes on the upper
extremities
Course in the ER
History was taken and physical examination was done. Vitals signs
were taken and recorded. The patient was given ivf of pnss 11x 16
hours, vitamin C 150mg/tan and paracetamol 500mg/tab.
Laboratory was requested of CBC,
PC, CREA, ALT ,blood typing and DENGUE NS1, DENGUE IgG,
DENGUE IgG
Admitting diagnosis:
DFS WITH WARNING SIGNS
UTI
The lab results of CBC: WBC 8,080/HGB 16.43 /HCT 48.74 /SEG 45/
LYM 31/ MONO 19/ EOS 3/ BASO 2/ PC 53,000/RBC 5.48/MCV 88.93/
MCH29.98/MCHC 33.71
ALT 280.6
BLOOD TYPEING A+
DENGUE NS1 POSITIVE
DENGUE IgG NEGATIVE
DENGUE IgG NEGATIVE
Medication:
Silymarin 140mg/tab OD, tramadole+paracetamol 1 tab BID,
levofloxacin 500mg/tab OD, Omeprazole 40mg IV OD and disfityl 1
tab TID.
Day 2(02/13/17)
The patient was awake ,no DOB, no chest pain ,no Abdominal pain
with vital signs of BP:100/70 PR:80 RR:20 T: 36.5 Normal PE iof
PINK,PC,(-) TPC,(-) CC AD, SCE, Soft ,nontender ,no mass.
Medication:
Levofloxacin 500mg/tab OD
CASE DISCUSSION
INTRODUCTION:
Most rapidly spreading viral disease in the world (by who). The
four countries in the western pacific region Philippines, Cambodia,
Malaysia and Vietnam has the highest no of cases reported. Dengue
is all-year round in Philippines.
CLASSIFICATION OF DENGUE:
Denguewithoutwarningsigns
Denguewithwarningsigns
Severedengue
Severe dengue
Lives in or travels to a dengue endemic area with fever of 2-7 days
and any of the above clinical manifestations for dengue with or
without warning signs, plus any of the following:
Severe plasma leakage, leading to:
Shock
Fluid accumulation with respiratory distress
Severe bleeding
Severe organ impairment
Liver: AST or ALT > or equal to 1000
CNS: e.g., seizures, impaired consciousness
Heart: e.g., myocarditis
Kidneys: e.g., renal failure
MANAGEMENT:
Patient who may be sent home (group A)
cantolerateadequatevolumesoforalfluids
Passurineatleastevery6hours
Donothaveanywarningsigns,particularlywhenfeversubsides.
Stablehematocrit
ACTION PLAN
Oral rehydration solution (ORS) should be given based on weight.
Reduce osmolarity of ORS containing sodium 45 to 60 mmol/ litre..
Sport drinks should not be given.
HOME CARE:
Adequate bed rest Adequate fluid intake(>5 glasses): milk, fruit
juice, isotonic electrolyte solution(ORS) and barley/rice water. Take
paracetamol (not more than 4 grms per day). Tepid sponging. Look
for mosquito breeding places around the home. Do not take NSAIDs,
e.g. acetylsalicylic acid (aspirin). Antibiotics are not necessary. If
warning signs for danger are observed ,take the patient immediately
to the nearest hospital.