50 YEAR OLD MALE PATIENT WITH FEVER AND SOB

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A 50 year old male patient who is farmer by occupation came with a chief complaints of fever since ten days,lethargy, blood in saliva since 3 days and SOB since 2 days.

Patient was asymptomatic 10 days back and later developed low grade fever of intermittent type which was relived on medication and was not associated with chills and rigor.The patient was lethargic so he consulted a local doctor and was diagnosed to have Dengue NS1

His platelet count was : 44,000 on day 1  

22,000 on 2nd day

Following one SDP transfusion, it became 

 33,000 on 3rd day

From 3 days patient noticed blood in saliva while coughing.His SOB progressed from grade 2 to 4.

PAST HISTORY :

Not known case of Diabetes, Hypertension , Asthma , TB , Epilepsy .

PERSONAL HISTORY :

Diet- mixed

Appetite- normal

Sleep- adequate

Bowel and bladder movements- regular

Addiction  : alcohol intake daily (30 ml whisky)

FAMILY HISTORY: 

Not significant

GENERAL EXAMINATION:

No Pallor , icterus, cyanosis, clubbing,lymphadenopathy, edema

SYSTEMIC EXAMINATION:

CVS: S1,S2 heard, no murmurs heard 

P/A: Soft, Non-tender

CNS: No abnormalities seen.

PROVISIONAL DIAGNOSIS : 

SEVERE ARDS with Dengue NS 1 reactive with Thrombocytopenia . ( H/O 1 SDP and 1 FFP transfusion )

TREATMENT : 

1. IVF NS , RL @ 75 ml/hr

2. Daily postural BP monitoring

3. W/F Bleeding manifestation

4. I/O strict monitoring