A 60 year old female with high grade fever ,weakness since 12 days

History of presenting Illness:

Patient was apparently asymptomatic 12 days back then she developed fever which is sudden in onset, continuous, with chills and no rigor ,no evening rise of temperature.

Patient complains of backache since 12 days , continuous which is insidious in onset,pain is confined to shoulder mostly ,dull aching type,non radiating,with no aggravating and relieving factors.

Patient complains of Generalised Weakness since 12 days 
 
Patient went to RMP doctor ,used medicines for 2 days which didn't subside ,so they went to Nalgonda government hospital and was diagnosed with dengue and low platelet count ,medicines were taken for 3 days which gave no relief 
Patient went to miryalaguda  hospital on 28 December  , got admitted and came to KIMS for further management .


Past History:
Patient has no similar complaints in the past
No history of Diabetes mellitus, hypertension,asthma, epilepsy, tuberculosis.

Personal History:
Patient takes mixed diet, appetite is decreased, bladder movement is normal, patient complains of decreased bowel movements.
Addictions: Patient consumes alcohol occasionally (1-2pegs).
      Patient smokes chutta since 40 years 1-2 per day.
Patient has no known allergies

Family History:
No significant family History

Treatment History:
Antipyretics , Antibiotics (unknown)

General Examination
Patient is conscious coherent coopertive well oriented to time, place and person. She is well built and well nourished.

Pallor- Present



Icterus- present 


Cyanosis - Absent

Clubbing - Absent

 Generalised Lymphadenopathy- Absent

Bilateral Pedal Edema is present.



Vitals: 
Temperature:febrile
BP- 110/70 mmHg
Pulse-81 beats per minute 
RR- 16

Systemic Examination:

Abdominal Examination -

On Inspection: 
 Abdominal Distension is present 
Umbilcus is at centre (slit like) No dilated veins,No scars,sinuses.



Palpation:No local rise in temperature
 Tenderness is elicited in the Right Hypochondrium .
No visible pulsations
No organomegaly

Percussion:

Auscultation:
Bowel sounds heard

Cardiovascular system:
S1 S2 heard ,no murmurs

Respiratory system:
Bilateral Air entry present
Normal vesicular breath sounds heard 

Central Nervous system:
Higher mental function intact 
No focal neurological deficit


Investigations:
1-01-23
2-1-23
2-1-23
3-1-23

4-01-23
4-01-23
4-01-23
5-01-23
Platelets:
On 31/12/22-26000/mm3
1/1/23-22000/mm3
2/1/23-28000/mm3
3/1/23- 16000/mm3
4/1/23-26000/mm3
5/1/22-25000/mm3
                        31/12/22. 1/1/23. 2/1/23
SGOT levels.              127     123        128
SGPT Levels.                62      69         67
Alkaline phosphatase 682   843    915
Provisional Diagnosis:
Dengue fever with Thrombocytopenia with Acute Kidney injury ,Acute Liver injury.
Treatment:
IV fluids -Normal saline with 1 ampoule of optineuron 
-Injection Noradr 2 ampoules in 46 ml NS
Inj PAN 40mgIV/OD
Tab PCM PO/TID
Inj Neomol .


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