70yr OLD MALE WITH DENGUE SHOCK SYNDROME
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I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan
A 70yr old male, agriculture by occupation was brought to casualty in an Unconscious state since yesterday
Patient was apparently asymptomatic 1 week back after which he started Binge drinking for 2 days and then he developed Fever that last for 3 days and developed Abdominal pain Burning type both for which he was treated by local Doctor.
After that he developed weakness which is gradual in onset and was unable to stand for which he was admitted to loacl hospital where he was diagnosed to have DENGUE FEVER (through NS1 ANTIGEN Positive) and the Platelet Count was 24,000.
He Wasn't responding for commands since yesterday evening and became unconscious since yesterday night and he was brought here to our hospital today morning.
Patient is a known case of Chronic Alcoholism since 30 years and increased his intensity since last 3 years.
smoking since 20 yrs, average 2 beedi per day
At the Time of Presentation
BP: 90/60mmhg
PR: 102bpm
GRBS: 34mg/dl
Temperature: 99°F
RR: 36cpm
SpO2: 85% with 4 Liters of O2
Severe Thrombocytopenia with Bleeding Manifestations (Epistaxis)
Patient was initially given in Casualty:
1. 25% Dextrose for Hypoglycemia
2. IVF. NS Bolus 1 Liter
On Examination
Patient was Unconscious
Icterus present
Patient was in gasping state, In view of falling saturation and risk of aspiration and low GCS patient was Intubated and kept on Mechanical Ventilation.
Post Intubation Xray
 |
| Post Intubation Xray |
Provisional diagnosis:
Dengue shock syndrome
(??Dengue encephalitis)
With hepatitis SECONDARY to Dengue? Alcohol??
With Pre renal AKI
Lab Investigations:
 |
| ABG Post Intubation |
 |
| @08:00 AM |
 |
| @03:45 PM |
 |
| @11:00 PM |
Treatment:
DAY 1
1. IVF NS,RL @150ML/HR
2. INJ. AUGUMENTIN 1.2GM IV/BD
3. INJ. PANTOP 40MG IV/OD
4. INJ. TRANEXA 500MG IV STAT
5. INJ. VIT K IV/OD
6. RT FEEDS 200ML FREE WATER - 1 HRLY, 200ML MILK PROTEIN POWDER - 2ND HRLY
7. SYRUP. LACTUOSE 15ML/BD
8. 1 UNIT SDP TRANSFUSION
9. BP/PR/ TEMP MONITORING 2ND HRLY
10.ABG 8TH HRLY
11. DAILY PCV, PLATELETS MONITORING
DAY 2
1. INJ. AUGUMENTIN 1.2GM IV/BD
2. INJ. PANTOP 40MG IV/OD
3. INJ. HYDROCORT 100MG IV BD
4. INJ. THIAMINE 200MG IV IN 100ML NS IV/BD
5. IVF NS, RL @100ML/HR
6. SYRUP. LACTULOSE 10ML PO/BD
7. RT FEEDS 300ML FREE WATER - 1 HRLY, 200ML MILK PROTEIN POWDER - 2ND HRLY
8. DAILY PCV, PLATELETS MONITORING
9. ABG 12TH HRLY
10. BP/PR/TEMP MONITORING 1HRLY
11. ENEMA SOAP WATER/PROCTOLYTICS
12. NEBULIZATION WITH MUCOMIST, BUDECORT 6TH HRLY
13. NO IM INJECTION
Day 3
@ 06:50AM
In view of falling saturation and BP not recordable &pulselessness, CPR was initiated
INJ. ADRENALINE was given
@06:50am BP,PR not Recordable - INJ.ADRENALINE 1gm IV/STAT
@06:55am BP,PR not Recordable - INJ.ADRENALINE 1gm IV/STAT
@07:00am BP,PR not Recordable - INJ.ADRENALINE 1gm IV/STAT
@07:05am BP,PR not Recordable - INJ.ADRENALINE 1gm IV/STAT
@07:10am BP,PR not Recordable - INJ.ADRENALINE 1gm IV/STAT
@07:15am BP,PR not Recordable - INJ.ADRENALINE 1gm IV/STAT
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