A 40 year male farmer had come with chief complaints of Fever since 10 days, Lethargy since 4 days, Blood in saliva since 3 days and SOB since 2 days .

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 a series of inputs available global online community of experts with the aim to solve the patient’s clinical problems with the collective current best evidence based inputs. This E log reflects my patient centred online learning portfolio and your valuable inputs in the comments section. 

40 year male farmer had come with chief complaints of Fever  since 10 days, Lethargy since 4 days, Blood in saliva  since 3 days and SOB since 2 days .

HOPI :

Patient was apparently alright 10 days back then he had low grade fever , intermittent , relieved on taking medication . Not associated with chills and rigors and doing his routine works , from 4 days as patient was lethargic and taken to local hospital found out to be Dengue NS 1 + and platelet count was
 44,000 on 1/3 
 22,000 on 2/3 ( one SDP transfusion )  
 33,000 on 3/3 
From 3 days patient notices blood in saliva and while during coughing associated with Black coloured stools from 2 days , patient is having Grade 2 --- Grade 4 .

PAST HISTORY :
Not known case of DM2 , Hypertension , Asthma , TB , Epilepsy .

PERSONAL HISTORY :
Diet- mixed
Appetite- normal
Sleep- adequate
Bowel and bladder movements- regular
Addiction  : alcohol intake daily 30 ml whisky

FAMILY HISTORY: 
Not significant

GENERAL EXAMINATION:
No Pallor 
No icterus,
No cyanosis,
No clubbing,
No koilonychia, 
No lymphadenopathy, 
No edema

VITALS 
Temp.- Afebrile
PR- 55 bpm
RR- 40 cpm
BP- 130/70 mmHg
SpO2- 92% at RA , 98% on 4 lit O2
GRBS- 137 mg/dl

SYSTEMIC EXAMINATION:

PER ABDOMEN : NON DISTENDED, SOFT NON-TENDER, NO GAURDING/RIGIDITY
CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
CENTRAL NERVOUS SYSTEM : NAD




















provisional diagnosis : 
 ARDS with Dengue NS 1 reactive with Thrombocytopenia .

TREATMENT : 
1. IVF NS , RL @ 75 ml/hr
2. Daily postural BP monitoring
3. W/F Bleeding manifestation
4. I/O strict monitoring

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