Viral pyrexia with NS1 +ve

"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment."

13yr old male came with c/o fever , vomitings , loss of appetite since 5days .

HOPI-

Patient was apparently asymptomatic 5days back.H/o fever -high grade associated with chills & rigors assoc.  with vomitings of 1episode - non bilious , non projectile , food as content . Vomitings subsided on 2nd day. Fever continued , patient was taken to RMP  , he was put on TAB PCM 500mg PO/OD , TAB chloroquine 250mg PO/BD , TAB PAN-D PO/OD, TAB VOVERON PO/TID .As fever not subsided , patient was put TAB cefixime 200mg PO/BD . Vomitings 5episodes non bilious , non projectile , food as content assoc with pain abdomen which is  diffuse type , colicky type .

No H/o loose stools , Malena , hematuria , petechiae .

Past history:

Appendicectomy was done 2months back .

No H/o HTN, DM,TB, Asthma ,CAD.

Family history -Not significant 

Personal history - 

Diet - mixed 

Appetite - decreased since 5days 

Sleep - adequate 

Bowel & bladder movements - regular 

No addictions.

General Examination :

Patient is c/c/c 

No pallor, icterus ,cyanosis, clubbing , lymphadenopathy , edema 

Vitals-

Temp -Afebrile

PR - 88BPM

RR -12 CPM

BP- 110/80 mmHg

SpO2- 98% @ RA

Systemic examination-

P/A -Tenderness + (diffuse )

CVS -S1 S2 + , no murmurs 

RS - BAE + 

CNS -NAD 

Provisional diagnosis 

Viral pyrexia with bicytopenia 

Treatment 

IVF NS,RL,DNS-  UO+30ML/HR

INJ PANTOP 40MG IV /OD

INJ ZOFER 2MG IV/TID 

INJ NEOMAL 100ML IV /SOS 

TAB PCM 500MG PO/TID 

OINT. T-BAC L/A over scar

Investigations 

Day 1

S-

c/o vomitings 

O-

Pt is c/c/c

Temp -Afebrile

PR - 88BPM

BP- 110/80 mmHg

SpO2- 98% @ RA

P/A -soft , non tender

CVS -S1 S2 + , no murmurs 

RS - BAE + 

CNS -NAD 

A-

Viral pyrexia with bicytopenia 

P-

IVF NS,RL,DNS-  UO+30ML/HR

INJ PANTOP 40MG IV /OD

INJ ZOFER 2MG IV/TID 

INJ NEOMAL 100ML IV /SOS 

TAB PCM 500MG PO/TID 

OINT. T-BAC L/A over scar

Day 2 

S- 

Pain abdomen decreased , no fever spikes & vomitings 

O-

Pt is c/c/c

Temp -Afebrile

PR - 76 BPM

BP- SUPINE-110/70 mmHg

STANDING -90/60 mmHG

SpO2- 98% @ RA

P/A - soft , non tender

CVS -S1 S2 + , no murmurs 

RS - BAE + 

CNS -NAD 

A-

Viral pyrexia with bicytopenia 

P-

IVF NS,RL,DNS-  75ML/HR

INJ PANTOP 40MG IV /OD

INJ ZOFER 2MG IV/TID 

INJ NEOMAL 100ML IV /SOS 

TAB PCM 500MG PO/TID 

TAB HIFENAC -P PO/BD

OINT. T-BAC L/A over scar