46 YEAR OLD MALE WITH FEVER,ABDOMINAL DISTENSION AND DARK COLORED STOOLS

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.

A 46 year old male patient presenting with c/o :
• Fever since 6 days.
• Dark coloured stools since 6 days
• Yellowish discolouration of sclera and urine.
• Abdominal distention since 3 days 

History of presenting illness :
         Patient was apparently asymptomatic 6 days back following which
    He developed Fever which was associated with chills and cold and aggravated at night.

     3 days after fever started the patient developed abdominal distention which was insidious in onset and not progressing.

   5 days following fever the patient noticed blood in urine, associated with clots.(foleys inserted 4 days back and blood noticed in urobag.)

   Patient attenders noticed hyperpigmentation of skin over face.

Past history :
No similar complaints in the past 
No H/O of DM,HTN,ASTHMA, EPILEPSY,TB ,CVD

Personal history :
  Diet :mixed 
  Appetite : decreased 
  Sleep  : decreased 
  Bowel and bladder movements:regular
                                            -burning micturition 

Family history :
  Not significant 

General examination:

Patient is consious, coherent, cooperative.
Signs of icterus in sclera and eyes
No signs of clubbing, lymphadenopathy, edema

Vitals: 
Temp: 98.6 F
PR: 84 bpm
RR: 20 cpm
Grbs: 115 mg/dl
Spo2: 98%

SYSTEMIC EXAMINATION:
CVS :S1 S2 Heard
RS :Bilateral air entry+
Per abdomen  :Soft and non tender 
CNS :No abnormalities detected 

Clinical Images:
     
         Abdominal distension
      
                Mild icterus 

Provisional diagnosis:
? Dengue hepatitis (NS Antigen +ve)


Plan of treatment:
1. Ivf NS/RL/DNS continuous at 100ml/hr
2. Inj. PAN 40mg IV BD 
3. inj. ZOFER 4mg IV/SOS
4. Inj. NEOMOL 1gm IV/SOS
5. Tab. PCM 650 mg PO/ SOS
6. Inj. OPTINEURON 1 AMP in 100ml NS IV/OD
7. W/F bleeding manifestations 
8. BP/PR/TEMP monitoring 4th hourly 
9. GRBS charting 12th hourly.


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