CASE STUDY ON Dengue Fever by yogananthan pharm. D

Dengue fever

1. CASE STUDY ON Dengue Fever Yogananthan. K 18408127

2. Dengue fever is a mosquito-borne tropical disease caused by the dengue virus . It is frequently asymptomatic ; if symptoms appear they typically begin 3 to 14 days after infection. The dengue virus has four confirmed serotypes ; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. The symptoms of dengue resemble many other diseases including malaria , influenza , and Zika . Dengue is spread by several species of female mosquitoes of the Aedes genus, principally Aedes aegypti . SIGNS AND SYMPTOMS: The characteristic symptoms of mild dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, nausea, vomiting, swollen glands and a rash. If this progresses to severe dengue the symptoms are severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool, extreme thirst, pale and cold skin, and feelings of weakness. INTRODUCTION

3. PATIENT DEMOGRAPHIC DETAILS Patient Name : Mr. A Age : 9 years Gender : Male Date Of Admission : 13/10/2023 Date Of Discharge : 19/10/2023 Department : Paediatrics

4. SUBJECTIVE EVIDENCE A 9 years old male patient was admitted to paediatrics ward on 13/10/2023 with chief complaints of High grade fever for 1 day Headache (behind the eyes) for 1 day Giddiness and Loss of appetite for 1 day PAST MEDICAL HISTORY: K/C/O Bronchial Asthma for 1 year PAST MEDICATION HISTORY: Neb. Asthalin (0.5ml + 2.5ml NS) x P/N x S.O.S

5. SOCIAL HISTORY: Nothing significant FAMILY HISTORY: Nothing significant DRUG ALLERGY: No drug allergies reported

6. OBJECTIVE EVIDENCE The patient is conscious and oriented with no obvious signs of Pallor, Icterus, Clubbing, Cyanosis, Lymphadenopathy, Edema on presentation. GENERAL EXAMINATION: Blood Pressure : 135 /92 mmHg Pulse Rate : 92 beats per minute Temp : 102.9 F Respiratory Rate : 21 breaths per minute SYSTEMIC EXAMINATION: CVS : S1S2 + RS : NVBS CNS : NFND P/A : Soft

7. LABORATORY INVESTIGATIONS H AEMATOLOGICAL PARAMETERS PARAMETERS OBSERVED VALUE BIOLOGICAL REFERENCE Hb 1 1.5 g/dl 13 - 17 g/dl Total RBC Count 4.81 million/ mm3 3.8 - 4.8 million/ mm3 WBC 11,900 cells /mm3 4000 - 10000 cells/ mm3 Neutrophils 53.5% 40 - 80% Lymphocytes 31.9% 20 - 40% Monocytes 14.6% 2 - 10% MCV 79.4 fl 83 - 101 fl MCH 23.9 pg 27 - 32 pg MCHC 35.2 g/dl 31.5 - 34.5 g/dl Platelet Count 1,10,000 200000 - 400000

8. Blood Sugar PARAMETERS OBSERVED VALUES BIOLOGICAL REFERENCE Random Blood Sugar 93 mg/dl 70 - 140 mg/dl Renal Function Tests Urea 25 mg/dl 15 - 40 mg/dl Creatinine 0.6 mg/dl 0.5 - 1.2 mg/dl Liver Function Tests Bili (T) 0.4 mg/dl 0.5 - 1.0 mg/dl Bili (D) 0.3 mg/dl Upto 0.3 mg/dl SGPT 5 U/L 5 - 35 U/L

9. Liver Function Tests PARAMETERS OBSERVED VALUES BIOLOGICAL REFERENCE SGOT 15 U/L 5 - 40 U/L Total Protein 6.4 g/dl 6 - 8 g/dl Alkaline Phosphatase NS 40 - 125 U/L Albumin 4.4 g/dl 3.5 - 5.0 g/dl

10. Other Investigations Dengue Serology (15.10.23) NS1 - 11.23 Imp: Positive USG Abdomen and pelvis Mesentric Lymphadenopathy

11. ASSESSMENT DIAGNOSIS: Based on the subjective and the objective examination outcomes, the patient was diagnosed with Dengue Fever

12. GOALS OF THERAPY To relieve the discomfort experienced by the patient To reduce the pathogen’s virulence

13. TREATMENT S.NO BRAND NAME GENERIC NAME DOSE ROA FREQUENCY DAYS 1 IV. RL IV. NS Ringer’s Lactate Normal Saline 1 pint IV B D 13 /10 - 15/10 16/10 - 19/10 2 INJ. Taxim Cefotaxime 500 mg IV B D 13 /10 3 INJ. Para Acetaminophen 50 0 mg IV B D 13 /10 - 18/10 4 INJ. Pan Pantoprazole 40 mg IV B D 13 /10 5 ORS Sachet Electrolyte 1 sachet in 1L water P/O O D 13 /10 - 17/10 6 INJ. Xone Ceftriaxone 1 g IV B D 14 /10- 17/10 7 INJ. Amikacin Amikacin 500 mg IV BD 14 /10 - 17/10

14. TREATMENT S.NO BRAND NAME GENERIC NAME DOSE ROA FREQUENCY DAYS 8 CAP. Doxy Doxycycline 100 mg P/O BD 18 /10 - 19/10 9 INJ. Para Acetaminophen 5 ml IV Stat 1 9/10 10 TAB. Para Acetaminophen 1 g P/O ½ TDS 18 /10 - 19/10 11 INJ. Rantac Ranitidine 2 cc IV BD 14 /10 - 16/10 12 INJ. Emeset Ondansetron 2 cc IV BD 14 /10 - 16/10 13 SYP. CPM Chlorpheneramine Maleate 5 ml P/O OD 14 /10 - 19/10

15. DRUG INTERACTION No possible Drug - Drug interactions found in the prescribed medications.

16. PHARMACIST INTERVENTION The patient was found to be allergic to Paracetamol as they developed swollen lips after administered . This allergic reaction was identified on 18/10 for which Avil was suggested as the therapy for allergic reaction. But, eventually the reaction subsided after discontinuation of Paracetamol

17. DRUGS ON DISCHARGE S.NO DRUGS NAME DOSE FREQUENCY R.O.A DURATION 1 Tab. CPM 1 tab OD P/O 1 week

18. Pat ient counseling Rest and plenty of oral fluids are recommended, along with regular consultations with the doctor. If the child starts to feel worse in the first 24 hours after his fever goes down, the guardian should get him to a hospital immediately to be checked for complications. Stay away from heavily populated residential areas, if possible. Use mosquito repellents, even indoors. When outdoors, wear long-sleeved shirts and long pants tucked into socks. When indoors, use air conditioning if available. Make sure window and door screens are secure and free of holes. If sleeping areas are not screened or air-conditioned, use mosquito nets.

19. Pheniramine Pheniramine is a first-generation antihistamine in the alkylamine class, similar to brompheniramine and chlorpheniramine. It is used in some over-the-counter allergy as well as cold & flu products in combination with other drugs. Pheniramine's use as an anti-allergy medication has largely been supplanted by second-generation antihistamines such as cetirizine and loratadine. Mechanism of Action: Pheniramine competes with histamine for the histamine H1 receptor, acting as an inverse agonist once bound. The reduction in H1 receptor activity is responsible for reduced itching as well as reduced vasodilation and capillary leakage leading to less redness and edema. This can be seen in the suppression of the histamine-induced wheal (swelling) and flare (vasodilation) response. Inverse agonism of the H1 receptor in the CNS is also responsible for the sedation produced by first-generation antihistamines like pheniramine. The binding of pheniramine to H4 receptors, and subsequent inverse agonism, may also contribute to reduced itching by antagonizing inflammation.

20. Pheniramine Pharmacodynamics: Pheniramine acts as an antagonist to allergic symptoms stemming from inappropriate histamine release to reduce edema, itching, and redness. The same antihistamine effect also produces sedation by acting in the central nervous system.

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