Viral pyrexia with thrombocytopenia
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30yr old male presented to GmOPD with chief complaints of
Fever since 3 days
Abdominal discomfort, epigastric pain since yesterday
Pt was apparently asymptomatic 3days back then developed fever which is continuous ass with chills and headache so pt went to RMP and received injections for fever then got relieved. Later that nighy, he again developed fever ass woth chills, next day he got admitted in miryalaguda hospital and was told to have low platelet count (17,000),he received fluids but the condition did not improve, so pt came to our hospital ,
No complaints of loose stools, vomitings, malena, burning micturition, blood in urine
Past history :
Past history of covid -19 1 yr back (admitted in hospital for complaints of fever, dry cough, sob) HRCT was done (12/25) he received Remedesvir injections (6 doses taken) and O2 given,At that time, he was told to have high sugar levels but no followup regular checkup were done nor the medication taken.
4yrs back, he had severe generalised pain abdomen for which he visited a local hospital -usg was done,,he was told to have Fatty Liver, from then he is having on and off complaints of abdominal discomfort.
Personalhistory:
Decreased appetite
Mixed diet
B&B : normal and regular
No known allergies
Occasional alcoholic since 4 yrs (whiskey 90ml)
No significant family history
On examination :
Pt is c/c/c
No signs of pallor, icterus, cyanosis, clubbing, generalisedlymphadenopathy,pedal edema.
Vitals:
Bp : 80/50
Afebrile
Grbs:542 mg%
Spo2: 98. %
Pr: 77 bpm
Systemic examination :
Cvs: S1S2 heard
R/s: BAE+,Nvbs heard
P/A: soft, non tender
Cns: NFND
provisional diagnosis :
Viral pyrexia with thrombocytopenia with
Serositis With k/c/o DM+
Investigations :
On 4/9/21:
on 6/9/21:
On 7/9/21:
On 8/9/21:
On 9/9/21:
Treatment :
0n 4/9/21:
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid after informing grbs
Grbs charting 4th hrly
I/o charting
Postural hypotension monitoring
T.Doxycycline 100 mg po/bd
W/F Bleeding manifestations
On 5/9/2021:
Subjective:
Abdominal discomfort,no stools passed
No complaints of giddiness,nausea
Objective:
Pt is c/c/c
Afebrile
PR 60 bpm
BP: standing-110/80
supine-90/60
Grbs-140mg/dl
Cvs_s 1 s2 heard
R/S- NVBS+
CNS- NAD
P/A- Distended, tenderness present in epigastric region and rt hypochondrium, free fluid +
Assessment:
Viral pyrexia with thrombocytopenia with shock
Serositis
With k/c/o DM+
Plan of care:
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid after informing grbs
Grbs charting 4th hrly
I/o charting
Postural hypotension monitoring
T.Doxycycline 100 mg po/bd
W/F Bleeding manifestations
On 6/9/21:
Abdominal discomfort,no stools passed
No complaints of giddiness,nausea
Objective:
Pt is c/c/c
Afebrile
PR 88 bpm
BP: 70/40
Cvs_s 1 s2 heard
R/S- NVBS+
CNS- NAD
P/A- Distended, tenderness present in epigastric region and rt hypochondrium, free fluid +
Assessment:
Viral pyrexia with thrombocytopenia with shock
Serositis
With k/c/o DM+
Plan of care:
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid after informing grbs
Grbs charting 4th hrly
I/o charting
Postural hypotension monitoring
T.Doxycycline 100 mg po/bd
Inj Noradrenaline 2 ampules in 46 ML NS @4 ML PER hr increase or decrease to maintain MAP >55
W/F Bleeding manifestations
On 7/9/21:
Subjective: c/o black colored stools 3 episodes since yesterday
Objective:
Pt is c/c/c
Afebrile
PR 84bpm
BP: standing 120/60
Supine-90/60
Grbs-131
Cvs_s 1 s2 heard
R/S- NVBS+
CNS- NAD
P/A- soft,no tenderness
Assessment:
Viral pyrexia with thrombocytopenia with Serositis
With k/c/o DM+
Plan of care:
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid after informing grbs
Grbs charting 6th hrly
I/o charting
BP monitoring ,PR,RR 2nd hrly
Postural hypotension monitoring 2nd hrly
T.Doxycycline 100 mg po/bd
Inj Noradrenaline 2 ampules in 46 ML NS @4 ML PER hr increase or decrease to maintain MAP >55
W/F Bleeding manifestations
On 8/9/21:
Subjective:
One episode of fever yesterday
Passed stools yesterday
One episode of vomiting after food intake -non bilious, non projectile ,food as content not ass with pain abd/loose stools
Objective:
Pt is c/c/c
Afebrile
PR 68bpm
BP: standing 120/80
Supine-90/60
Grbs-148
Spo2-95%with RA
Cvs_s 1 s2 heard
R/S- NVBS+
CNS- NAD
P/A- soft,no tenderness ,free fluid +
Assessment:
Viral pyrexia with thrombocytopenia with Serositis with shock with ? Viral hepatitis
With k/c/o DM+
Plan of care:
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid after informing grbs
Grbs charting 6th hrly
I/o charting
BP monitoring ,PR,RR 2nd hrly
Postural hypotension monitoring 2nd hrly
T.Doxycycline 100 mg po/bd
W/F Bleeding manifestations
.Doxycycline 100 mg po/bd
Inj Noradrenaline 2 ampules in 46 ML NS @4 ML PER hr increase or decrease to maintain MAP >55
On 9/9/21:
Subjective:
No fever spikes
Objective:
Pt is c/c/c
Afebrile
PR 68bpm
BP: standing 100/60
Supine-100/60
Grbs-172
Spo2-96%with RA
Cvs_s 1 s2 heard
R/S- NVBS+
CNS- NAD
P/A- soft
Assessment:
Viral pyrexia with thrombocytopenia with Serositis with shock (resolved)with ? Viral hepatitis
With k/c/o DM+
Plan of care:
T PCM 500mg po/sos
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid 6u-6u-4u
Grbs charting 6th hrly
I/o charting
PR,RR 2nd hrly
Postural hypotension monitoring 2nd hrly
T.Doxycycline 100 mg po/bd
On 10/9/21:
Subjective:
No fever spikes
Stools passed
Objective:
Pt is c/c/c
Afebrile
PR 86bpm
BP: 110/70 mmhg
Spo2-97%with RA
Cvs_s 1 s2 heard
R/S- NVBS+
CNS- NAD
P/A- soft
Assessment:
Viral pyrexia with thrombocytopenia with Serositis with shock (resolved)with ? Viral hepatitis
With k/c/o DM+
Plan of care:
T PCM 500mg po/sos
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid 6u-6u-4u
Grbs charting 6th hrly
I/o charting
PR,RR 2nd hrly
Postural hypotension monitoring 2nd hrly
T.Doxycycline 100 mg po/bd
On 11/9/21:
Subjective:
No fever spikes
Stools passed
Objective:
Pt is c/c/c
Afebrile
PR 86bpm
BP: 110/70 mmhg
Spo2-97%with RA
Cvs_s 1 s2 heard
R/S- NVBS+
CNS- NAD
P/A- soft
Assessment:
Viral pyrexia with thrombocytopenia with Serositis with shock (resolved)with ? Viral hepatitis
With k/c/o DM+
Plan of care:
T PCM 500mg po/sos
IVF NS,RL @150 ML/hr
Inj pantop 40 mg IV/od
Inj zofer 4 mg iv/SOS
Inj HAI /sc/tid 6u-6u-4u
Grbs charting 6th hrly
I/o charting
PR,RR 2nd hrly
Postural hypotension monitoring 2nd hrly
T.Doxycycline 100 mg po/bd
PLANNING FOR DISCHARGE
