G.Nagarjuna

A 45 year old female resident of nalgonda came to the causality with chief complaint of
Fever since 3 days

HOPI:
Patient was apparently asymptomatic  3 days
back then she developed fever ,high grade fever associated with chills and rigors
No c/o cough,cold,No c/o chest pain,palpitations, syncopal attacks
C/o nausea,no vomiting,loose stools
C/o burning micturition,decreased urine output
No c/o SOB,orthopnea,PND 
No c/o abdominal distension
No h/o HTN,CVA,CAD,TB,EPILEPSY
K/c/o DM since 2 years and on regular medication 

Family history :
No significant history 

Personal history:
Diet:mixed
Appetite:decreased 
Bowel and bladder:regular
Non alcoholic,non smoker

General examination :
Patient was coherent, conscious,cooperative 
Moderately built and Moderately nourished 

Vitals :
PR-80bpm
BP-110/80mmhg
RR-16cpm
Spo2-99%@ RA
GRBS-560 mg/dl

Per abdomen:
Shape:scaphoid
Soft,non tender 
No palpable masses 
Hernial orifices normal
Bowel sounds heard

Respiratory system:
Trachea: central
NVBS :heard 
No adventitious sounds heard

Cardiovascular system:
S1 S2 heard
No thrills,murmurs
 
Central nervous system:
Speech:normal
No signs of meningeal irritation
Motor and sensory systems :normal 
Cranial nerves:intact
Reflexes:present

Provisional diagnosis:
Viral Pyrexia with thrombocytopenia 

Investigations:
urine for ketone bodies: Negative 
Malaria parasite:negative
Blood group : O
Rh typing:Negative
Rapid HbSAg-negative
RapidHiv-negative
Anti HCV antibodies-negative 
Rapid dengue ns1-positive
Urea:43
S.creatinine-1.2
Na+: 134 meq/l
K+:4.5meq/l
Cl+: 96meq/l

LFT:
Tb-0.92mg/dl
Db:0.2mg/dl
Ast: 107 units/l
Alt:81 
Alp:208
Alb-3.3
A/g ratio-1.15
31-8-21
1-9-21
2-9-21
3-9-21
Hb-13.1gm/dl
Tlc-5700 cells/cumm
Rbc-4.60 millions/cumm
Plt-80000lakhs/cumm

4-9-21
Hb-12.8gm/dl
Tlc-6300 cells/cumm
Rbc-4.54millions/cumm
Plt-1.2lakhs/cumm
Serum creatinine-

Diagnosis:
Dengue with thrombocytopenia
K/c/0 Dm since 2 years 

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