A 25yr old female



A 25 yr old female housewife by occupation  resident of nalgonda came to general medicine OPD with 

Chief complaints:-

Body pains since 6 days

Fever since 3 days

History of presenting illness:-

Patient was apparently asymptomatic 6 days back then she started developing body pains  insidious in onset ,gradually progressive, dragging type symmetrical in nature small joints are involved more not associated with swelling local rise of temperature and redness,aggregated vated during fever no relieving factors 

Fever since 3 days sudden in onset continues in nature high grade associated with chills and rigors relieving on medication no aggravating factors

Headache since 3 days during fever dragging type relived on medication and rest

History of Vomitings 4 days back projectile type non bilious 3-4 episodes 

History of watery loose stools 4 days back 3-4 episodes 

History of petechial rash on left fore arm one day of admission after applying Bp cuff 

No history of cough,night sweats, abdominal pain,pedal oedema retro orbital pain.

Daily routine 

Before 

Wakes at 8am eats breakfast at 9am and then does the household work lunch at 1pm and at 5pm drinks milk and at 9pm eats dinner then sleeps at 11pm

After 

wakes at 9am could not do household work she was feed by her mother she ate 1/4th of quantity of food sleeps from 2 to 6pm ate her dinner at 9pm and sleeps at 11pm

Past history 

N/k/c/o diabetes mellitus hypertension tuberculosis asthma epilepsy cardiovascular diseases

History of LSCS 6 Months ago

Family history 

Not significant

Personal history 

Mixed diet 
Decreased appetite 
Regular bowel and bladder movements 
Adequate sleep
No addictions 
No known allergies

General examination 

Patient is conscious coherent and coperative well oriented to time place and person.Moderately built and moderately Nourished.  

Vitals : 

Afebrile

BP 110/80mmhg

PR 84bpm

Respiratory rate 15 cpm

No pallor, icterus, clubbing, cyanosis, lymphadenopathy ,Pedal Edema.





Hess test: positive


Systemic examination : 

CVS system

No thrills
Cardiac sounds are heard
No cardiac murmurs

Respiratory system

No dyspnoea 
No wheeze
Trachea is centrally positioned 
Vesicular breath sounds
No adventitious sounds 

Abdomen 

shape abdomen 
No tenderness, palpable mass
Normal hernial orifices
Non palpable liver, spleen
No free fluid 
Bowel sounds heard

CNS examination:

Conscious and alert
Normal speech 
No focal neurological deficits
No signs of meningeal irritation

Provisional diagnosis

Viral pyrexia Dengue

Investigations




























Treatment 

Day 1
IV fluids NS 75ml/hr
Tab Doxy 100mg po/bd
Inj optineuron in NS
Inj zofer 4mg iv/bd
Inj pantop 40mg od
Ors sachet
Temperature charting 4th hrly

Day 2

IV fluids NS 75ml/hr
Tab Doxy 100mg po/bd
Inj optineuron in NS
Inj zofer 4mg iv/bd
Inj pcm 1gm if fever rises
Ors sachet
Temperature charting 4th hrly

Day 3

IV fluids NS 75ml/hr
Tab Doxy 100mg po/bd
Inj optineuron in NS
Inj zofer 4mg iv/bd
Inj pcm 1gm if fever rises
Ors sachet
Temperature charting 4th hrly

LEARNING POINTS 

I learnt about the importance of daily charting of fever.
Importance of daily measurement of hematocrit in dengue
Importance of input and output 
Diagnosis of hypovolemia by blood pressure 


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