13 YEAR OLD BOY COMPLAINTS OF HIGH GRADE FEVER SINCE 4 DAYS

13 YEAR OLD BOY COMPLAINTS OF HIGH GRADE FEVER SINCE 4 DAYS

A 13 year old school going boy complaints of 

- high grade fever since 4 days

- vomitings since 4 days

- giddiness ince 4 days

- loose stools since 1 day

Patient was apparently asymptomatic 4 days back then he developed fever associated with chillschills. 

Complaints of vomiting since 4 days- 2-3 episodes/day with food particles as content

Loose stools- 5 episodes in the past one day

No history of burning micturition, melena, rashes, bleeding gums, hematuria

VITALS

Temp- 98.8 F

PR- 90 bpm

BP- 100/60 mmHg 

RR- 18 cpm

Spo2- 98% at RA

GRBS- 118mg%

GENERAL EXAMINATION

Patient is conscious, coherent and cooperative. 

No signs of Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy or Edema.

SYSTEMIC EXAMINATION

CVS: S1 S2 heard, no murmurs/thrills

RS: BAE+, NVBS heard

PA: Soft, non tender. Liver and Spleen not palpable. Bowel sounds heard.

CNS: NFND

PROVISIONAL DIAGNOSIS

NS 1 + DENGUE

INVESTIGATIONS

Outside Reports:

Platelets- 102000 lakhs/cu.mm

Hb- 15.6 mg/dl

TLC- 2,300

PLT- 45,000

Hct- 42.1

BGT- AB POSITIVE

BLOOD MALARIAL PARASITE- NEGATIVE

RBS- 110 mg/dl

DENGUE NS1 +

Serum Urea- 13

Serum Creatinine- 0.6

Na- 135

K- 3.0

Cl- 96

Total Bilirubin- 0.40

Direct Bilirubin- 0.18

AST- 10

ALT- 9

ALP- 110

TP- 4.0

ALB- 2.0

A/G- 1.0

USG ABDOMEN

 ECG

CHEST XRAY

TREATMENT

1. IVF NS, RL, DNS @100ml/hr continuous

2. Inj PANTOP 40 mg IV OF

3. Plenty of oral fluids

4. Inj ZOFER 4mg IV TID

5. W/F Bleeding manifestations, postural hypotension

6. ORS sachets in 1 litre of water, 200 ml after each stool

7. Tab DOLO 650 mg PO SOS

8. Inj NEOMOL 1g IV SOS (if temp>101.1 F) 

9. Temp chatting fourth hourly

10. BP/PR chatting fourth hourly

11. Syp GRILINCTUS LS 10 ml PO BD

12. Syp POTCHLOR 10 ml in glass of water PO BD