DENGUE HEMORRHAGIC FEVER WITH ALTERED SENSORIUM

January 05-2023

This is an online e-log book to discuss our patient de-identified health data shared after taking his / her / guardian's signed informed consent. Here we discuss our individual patients' problems through a series of inputs from the available global online community of experts with an aim to solve those patients' clinical problems with collective current best evidence-based information.

This E blog also reflects my patient-centered online learning portfolio and your valuable input in the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and coming up with diagnosis and treatment plans. is an online e-log book to discuss our patient's de-identified health data shared after taking his / her / guardians' signed informed consent. Here we discuss our individual patients' problems through a series of inputs from the available global online community of experts with an aim to solve those patients' clinical problems with collective current best evidence-based information.

CHIEF COMPLAINTS:

  A 50 yr old female resident of nalgonda came to opd with chief complaints of fever since 7 days 

Breathlessness and abdominal distenstion since 4 days 

Decreased urine out since 4 days.

HISTORY OF PRESENT ILLNESS:

patient was apparently asymptomatic 7 days back and then she developed fever which is insidious in onset and gradually progessive not associated with chills , myalgia , arthralgia .on the day 3 she developed breathlessness and abdominal distenstion with abdominal pain which are gradually progressive with no aggrevating or relieving factors . History of giddiness since 4 days .History of decreased urine output since 4 days , no history of hematuria , blood in stools .History of 2 episodes of vomiting on 4th day of fever ,vomitus containing food particals with no blood and bile , non projectile in nature.

PAST HISTORY:

history of fever 20 days back and treated by medication 

she’s is known case of diabetes 

No history of hypertension, asthma , epilepsy, tuberculosis.

PERSONAL HISTORY:

Diet mixed

appetite normal 

sleep adequate 

bowel and bladder moments are regular 

No addictions

FAMILY HISTORY:

No similar complaints in family 

TREATMENT HISTORY:

metformin 500 mg for diabetes 

Paracetamol for fever 10 days back

GENERAL EXAMINATION:

patient is conscious coherent cooperative , well oriented to time ,place and person

pallor -

icterus+

clubbing-

cyanosis-

koilonychia-

lymphadenopathy-

edema-

vitals:

temperature 98.7

pulse rate 82 bpm

respiratory rate 22cpm 

blood pressure 110/90

SYSTEMIC EXAMINATION:

perabdominal examination :

Inspection: 

shape : distended 

umbilcus : inverted 

movements: normal 

skin over abdomen : normal 

palpation: 

their is no local rise of temperature,

tenderness present in right hypochondrial region 

no organomegaly.

percussion:

liver: dullnote heard

shifting dullness heard

no fluid thrills 

Ausculatation :

Bowel sounds are heard.

cardiovascular system:

S1 and S2 heard , no murmurs

Respiratory system:

bilateral air entry present 

Normal vesicular breath sounds heard

Trachea position - central 

Central nervous system examination:

No focal neurological deficit.

Higher mental functions:

Oriented to time,place,person

Memory : Immediate,recent, remote intact

Speech: Normal

No delusions or hallucination

Cranial nerves: 

1- not tested

2- Pupillary reflex present

3,4,6- No restriction of movement of eye

5-normal( muscles of mastication+sensations of face)

7-Normal, wrinking of forehead seen, able to blow up cheeks

8- Normal hearing

Motor examination:

Tone -normal in both limbs 

Power-. Right Left

             Upper limb 5/5 5/5

              Lower limb 5/5 5/5

Reflexes :

Biceps: Right++

               Left: ++

Triceps: Right++

               Left: ++

Supinator: Right++

               Left: ++

Knee: Right: ++

           Left: ++

Ankle: Right: ++

             Left: ++

Cerebellum examination:

Able to do finger nose test.

PROVISIONAL DIAGNOSIS:

1.DENGUE HEMORRHAGIC FEVER 

2.Altered sensorium secondary to dengue encephalitis. 

INVESTIGATIONS:

TREATMENT:

1. ivf normal saline

2. Ringer’s lactate 

3. inj piptaz 2.25 gm iv tid

4.inj PAN40 mg iv od

5. syp lactulose 10 ml po bd

6. syp potklor 10 ml po tid.