Cerebral Malaria, Severe Dengue
This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.
This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.
I have 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 diagnosis and treatment plan.
A 28y/o male patient came to the casuality with
1. Altered sensorium
2. Fever
3. Headache
4. Vomitings
Patient was apparantly asymptomatic 1 week back. Then he had insidious onset of fever. It was low grade, intermittent, not associated with chills and rigors, relieved on taking medication. Fever was associated with headache. No blurring of vision. Vomitings were non prohectile, non bilious, non foul smelling, non blood stained and the content was food particles. No complaints of loose stools, pain abdomen, chest pain, palpitations.
Not a K/C/O DM, HTN, asthma, TB, epilepsy.
Examination
Temp 100.5
BP 90/60 mmHg
PR 84bpm
RR 20
SpO2 100
GRBS 39- Hypoglycemia -25% D given
Pallor +
icterus + ,cyanosis, clubbing of nails, lymphadenopathy or koilonychia
GCS 7/15 (E2V1M4)
Pupils - mid dilated ,reacting to light
Dolls eye - sluggish
No meningeal signs .
CVS- s1 and s2 present
RS- BAE + clear .
Diagnosis-
Severe Dengue ( Ns1+)
Hemolysis,coagulopathy ,
Acute fulminant hepatic failure .
? Cerebral malaria
Examination
Temp 100.5
BP 90/60 mmHg
PR 84bpm
RR 20
SpO2 100
GRBS 39- Hypoglycemia -25% D given
Pallor +
icterus + ,cyanosis, clubbing of nails, lymphadenopathy or koilonychia
GCS 7/15 (E2V1M4)
Pupils - mid dilated ,reacting to light
Dolls eye - sluggish
No meningeal signs .
CVS- s1 and s2 present
RS- BAE + clear .
Treatment given
1. IVF 1 NS at 100ml/hr, 2 DNS at 75ml/hr
2. RT feeds 200ml milk and protein powder every 2 hrs
3. Inj PANTOP 40mg IV/OD
4. Inj MONOCEF 1gm/IV/BD
5. Inj FALCIGO 120mg/IV/STAT
6. Inj ZOFER 4mg/IV/BD
7. Tab DOLO PO/BD
8. Inj DOXYCYCLINE 100mg /IV/BD
Day 1
Current Vitals -
Temp -98.4
PR-91/ min
RR-26/ min
BP-120/90 mmHg
GRBs -150 mg / dl
Input -1200 / 600 ml since mrng
Sr LDh - 4853
Urine high coloured
Metabolic acidosis with secondary resp alkalosis .
Mixed acid base disorder .
Expected paco2- 23
Observed - 14
Treatment given
1. IVF 1 NS at 100ml/hr, 2 DNS at 75ml/hr
2. RT feeds 200ml milk and protein powder every 2 hrs
3. Inj PANTOP 40mg IV/OD
4. Inj MONOCEF 1gm/IV/BD
5. Inj FALCIGO 120mg/IV/STAT
6. Inj ZOFER 4mg/IV/BD
7. Tab DOLO PO/BD
8. Inj DOXYCYCLINE 100mg /IV/BD
Day 2
1. IVF 1 NS at 100ml/hr, 2 DNS at 75ml/hr
2. RT feeds 200ml milk and protein powder every 2 hrs
3. Inj PANTOP 40mg IV/OD
4. Inj MONOCEF 1gm/IV/BD
5. Inj FALCIGO 120mg/IV/STAT
6. Inj ZOFER 4mg/IV/BD
7. Tab DOLO PO/BD
8. Inj DOXYCYCLINE 100mg /IV/BD
9. INJ LEVIPIL 1GM/IV/STAT
10.SYP.LACTULOSE 10ML/RT/OD
11. INJ.VIT-K 10MG IN 10 ML NS/IV/OD
12. INJ.MANNITOL 100ML/IV/TID
DEATH SUMMARY:
PATIENT CAME TO THE CASUALITY WITH ALTERED SENSORIUM(SINCE 1 DAY)WITH H/O FEVER,HEADACHE, VOMITINGS(SINCE 1 WEEK)
AFTER FURTHER INVESTIGATIONSPATIENT IS BEING DIAGNOSED WITH DENGUE HEMORHAGIC FEVER WITH ACUTE FULMINANT LIVER FAILURE, ?CEREBRAL MALARIA. ON 30/08/2021 AT 11.00PM, I/V/OFAILING SATURATIONPATIENT WAS INTUBATED AND CPR WAS DONE.DESPITE OF EFFORTS DONE PATIENT COULDN'T BE REVIVED AND DECLARED DEATH ON 30/08/2021 AT 11.50PM
IMMEDIATE CAUSE OF DEATH:SEVERE DENGUE, ACUTE FULMINANT HEPATIC FAILURE
ANTECEDENT CAUSE OF DEATH: VIRAL PYREXIA, DENGUE ONFECTION WITH MULTI ORGAN DYSFUNCTION
