Case presentation of Dengue Fever(1).pptx

Pediatrics

1. Case presentation of Dengue Fever Date: 2081/06/04 Presented by: Sudhir Shrestha , Sujana Dhimal

2. Patient particulars Name: Bal Krishna Paudel Age: 13 yrs Sex: Male Address: Nayabazar , Pokhara Religion: Hindu Education level: 8 class DOA: 2081/05/29 at 11:00pm via ER DOE: 2081/06/01 Informant: Mother, SLC pass, as patients stays with his mother so reliability is good .

3. Chief complaints: Fever x 2 days 2. Generalized bodyache x 2 days

4. History of presenting illness: According to informant, patient was on his usual state of health 2 days back then he developed fever which was acute on onset, intermittent type, initially fever was low grade(100 degree F) without chills and rigor. It was relieved on taking medication( Tab. Flexion) for 4 to 5 hours after which the temperature would rise again. After 1 day the fever progressed to high grade ( 103.8degree F) with chills and rigor. Tmax was 104 degree F. Child was lethergic during febrile period and did not consume regular amount of food which he would consume regularly Fever was associated with generalized body ache, retro orbital pain.

5. There was no history of rashes, throat pain, ear pain ,ear discharge, nasal congestion , runny nose, fast breathing , noisy breathing, cough, SOB, chest pain. Abdominal pain, loose stool, constipation, vomiting. Burning micturation , decreased urine output, lower abdominal pain. Headache, blurring of vision, altered sensorium , No any bleeding manifestation. No any recent travel history.

6. Past history : Patient was admitted to GMC 3 months back for Pneumonia. There was no history of similar illness in past. There was no history of TB, epilepsy, measles and other major illness in past.

7. Treatment history: He was treated for pneumonia conservatively with: Inj. Ceftrixone Inj. Tazolin Tab. PCM Nebulized with Asthalin . No any known drugs and food allergy.

8. Family history: There is no history of TB, HTN, DM and other chronic illness in family. No history of consanguinity. Genogram : 37 43 17 13

9. Nutritional history: Nutritional Requirement = 2750 k cal Before the onset of illness patient was taking 2 major meal containing rice, pulses, eggs , and vegetables, 2 snacks containing fruits ,breads and milk in between which was decreased during illness. His calorie intake is 2360kcal and protein intake is 119gm .

10. Food consumed Calories(kcal) Proteins (g) Breakfast (2egg ,2 bread ,milk ) 530 19.6 Lunch ( Rice, pulses ,vegetables ) 745 33.5 Snack ( 2 breads , milk ) 170 6.6 Dinner ( Rice ,pulses , vegetables , eggs ) 925 46.5

11. Socio-economic history: Patient lives in nuclear family with 4 members in Pakka house with father being a breadwinner. Total income of the family is Rs 50000/month. There is no history of smoking and alcohol intake. According to Kuppuswamy scale ,patient belongs to upper class with total score of 26.

12. General physical examination : Patient was conscious, cooperative, well looking and oriented to time, place and person lying comfortably in bed with blue cannula over dorsum of his left hand. Vitals: BP: 100/70 mmHg taken in right arm in sitting position. Pulse rate: 114 beats/min taken on right radial artery which was regular in rhythm, adequate in volume, normal in character, without radio-radial and radio-femoral delay. Respiratory rate: 28 breaths/min taken from foot end. Temperature: 98 degree F taken on right axilla.

13. Cardinal signs: There was no pallor, icterus , clubbing, cyanosis, edema, lymphadenopathy and dehydration.

14. Systemic examination : Respiratory system: Inspection: there is no gross deformity of nasal septum, nasal discharge, nasal congestion, enlarged tonsils, shape of the chest was normal with no deformity, bilaterally symmetrical in expansion, no scar marks, trachea centrally placed and no use of accessory muscle of respiration. Palpation: inspectory findings were confirmed, trachea centrally placed, bilaterally symmetrical chest expansion. Vocal fremitus equal on both side of chest. Percussion: resonant note heard bilaterally all over the lung field. Auscultation: bilaterally normal vesicular breath sound, no added sounds heard.

15. Per abdominal examination : Inspection: abdomen is flat, umbilicus central and inverted, all quadrants move equally with respiration, no scar marks and hernial orifices intact. Palpation: no local rise in temperature, no tenderness and organomegaly . Percussion: tympanic note present, no fluid thrill and shifting dullness. Auscultation: 3-4 bowels sound/min

16. CVS EXAMINATION Inspection: no precordial bulging . Palpation : apex beat was palpable in 5 th intercostal space 1 cm medial to left mid- clavicular line, thrill and heave were absent . Auscultation : S1S2M0

17. CNS EXAMINATION Mental status: alert and oriented, no signs of confusion or altered mental status. Any change in consciousness may indicate severe dengue or dengue encephalopathy. Cranial nerves: intact, no abnormalities. Motor and sensory functions: normal; no focal neurological deficits. Reflexes: normal.

18. Summary: 13 years, male from Nayabazar , Pokhara was admitted to GMC with complain of fever and generalized body ache for 2 days. Fever was acute, tmax : 104 F, intermittent type, with chills and rigor and was associated with generalized body ache and retro orbital pain. Patient is stable with vitals within normal limit. On systemic examination there was no any abnormal findings.

19. Investigation: CBC (2081/09/14) CBC (2081/09/17) WBC: 4.43 x 10^9/L Neutrophils : 63.7% Lymphocytes: 28.2 % Monocytes : 7.9% Eosinophils : 0.0 % Basophils : 0.2 % RBC: 3.97 x 10^12/L HBG: 10.6 gm /dl HCT: 31.7 % MCV: 79.8 fL MCH: 26.7 pg MCHC:33.4 gm/dl Platelets: 174x 10^9/L WBC: 3.86 x 10^9/L Neutrophils : 34.4 % Lymphocytes: 60.9 % Monocytes : 4.1 % Eosinophils : 0.3 % Basophils : 0.3% RBC: 4.22 x 10^12/L HBG: 11.1 gm /dl HCT: 32.8 % MCV: 77.7 fL MCH: 26.3 pg MCHC:33.8 gm/dl Platelets:137 x 10^9/L CRP: 18.1 mg/dl

20. Dengue NS1: positive Dengue IgG / IgM : negative Renal Function Test: Ur/ Cr: 20/0.7 mg/dl Na/K: 137/3.7 m.mol/l Liver Function Test : Total protein : 6.4 gm/dl Albumin :3.4gm/dl Globumin :3.0gm/dl Al/Gl:1.1 Total billirubin:0.8 mg/dl Direct billirubin:0.3 mg/dl Indirect Billirubin:0.5 mg/dl AST /ALT:18/16 U/L ALKP: 547 IUL

21. URINE ANALYSIS Color : Yellow Transparency: Clear PH : Acidic Protein : Nil Sugar: Nil URINE MICROSCOPY Pus cells : 2-34/ hpf RBC : Nil Epithelial cells : 1-3 / hpf

22. TREATMENT IVF NS II Pint + Inj DNS I Pint IV over 24 hours INJ PCM 615 MG IV SOS ( IF TEMP > 102 F) TAB PCM 500 MG PO QID TAB PANTOP 40 MG OD TAB AMOXICILLIN 500 MG PO TDS TAB VIT C 1 TAB PO OD SYP FORTIPLEX 10 ML PO BD

23. T/T at the day of discharge: TAB PCM 50 MG PO SOS SYP FORTIPLEX 10 ML PO OD X 15 ML TAB AMOXICILLIN 500 MG PO TDS X 4 DAYS

24. Differential diagnosis: Dengue fever without warning signs. Viral fever Scrub Typhus Enteric fever URTI LRTI UTI Rheumatic Disease