A 47 year old female with fever

A 47 YEAR OLD FEMALE WITH FEVER

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A 47 year old female,resident of Nalgonda came to our medicine OPD with chief complaints of 

Fever since 3 days which is of high grade and associated with chills

Pain abdomen since yesterday morning in the epigastrium

Vomitings since yesterday 5 episodes,non bilious ,non projectile

-No H/O cold,cough,headache, SOB, palpitations

-No H/O rash, ,loose stools,melena, constipation

- No H/O burning micturition, hematuria

PAST HISTORY-K/C/O Hypertension since 5 years on regular medication Tab.Olmesartan 40mg

Not a K/C/O DM,TB,Epilepsy,Asthma,CVD,CAD.

PERSONAL HISTORY-

Mixed diet 

Normal appetite 

Adequate sleep 

Regular bladder and bowel movements 

No addictions 

FAMILY HISTORY-

No similar complains in the family.

No history of Diabetes, Hypertension,TB, Asthma, CAD,CVD.

GENERAL EXAMINATION-

Patient was conscious, coherent, co- operative. Well oriented to time, place and person.

Moderately built and moderately nourished .

No pallor

No icterus

No clubbing

No cyanosis

No lymphadenopathy 

No edema 

VITALS-

TEMPERATURE- Afebrile

BP-130/90mm of hg

PR-90 BPM

RR-19 CPM

SPO2- 98% at Room air

GRBS- 93 mg/dl

SYSTEMIC EXAMINATION-

CVS EXAMINATION-

S1, S2 heard

No murmurs

RESPIRATORY SYSTEM EXAMINATION- 

Trachea-midline

Bilateral air entry present 

Normal vesicular breath sounds heard

No additional sounds

PER ABDOMINAL EXAMINATION-

INSPECTION-

Shape- Scaphoid 

Umbilicus- central and inverted

Movements with respiration- equal in all quadrants, rises with inspiration and falls during expiration 

No visible pulsations 

No visible scars or sinuses seen 

No engorged veins 

PALPATION-

No local rise of temperature 

No tenderness in any quadrants of abdomen

Liver and spleen- impalpable( no organomegaly)

PERCUSSION-

Tympanic note 

AUSCULTATION-

Bowel sounds present

CNS EXAMINATION-

No focal neurological deficits

INVESTIGATIONS-

DENGUE NS1 ANTIGEN -POSITIVE

PROVISIONAL DIAGNOSIS- VIRAL PYREXIA WITH THROMBOCYTOPENIA

WITH DENGUE NS1-POSITIVE

TREATMENT-

1. IV Fluids NS,RL@ 100 ml/hr

2.Plenty of oral fluids

3.Inj.Pan 40 mg/IV/OD

4.Tab.Olmesartan 40 mg/PO/OD

5. Inj.Tramadol 1 amp in 100 ml NS/IV/SOS

6.Inj.Zofer 4 mg/IV/BD

7.BP/PR/SPO2 monitoring